Provider Demographics
NPI:1629396692
Name:SHAH, CINDY L (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:L
Last Name:SHAH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PAULA BLVD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2631
Mailing Address - Country:US
Mailing Address - Phone:631-846-9194
Mailing Address - Fax:
Practice Address - Street 1:21 PAULA BLVD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2631
Practice Address - Country:US
Practice Address - Phone:631-846-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257767164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse