Provider Demographics
NPI:1689918344
Name:SCOTT, SHANA (LPN)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SCOTT
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 1:68 CUNNINGHAM ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-3010
Mailing Address - Country:US
Mailing Address - Phone:585-851-5667
Mailing Address - Fax:
Practice Address - Street 1:68 CUNNINGHAM ST
Practice Address - Street 2:APARTMENT 3
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-3010
Practice Address - Country:US
Practice Address - Phone:585-851-5667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311828164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse