Provider Demographics
NPI:1699040907
Name:SHENE, BETHANY (LPN)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SHENE
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:PO BOX 1994
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-0908
Mailing Address - Country:US
Mailing Address - Phone:631-324-9555
Mailing Address - Fax:631-458-1426
Practice Address - Street 1:1 MCGRATH STAND LN
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-2830
Practice Address - Country:US
Practice Address - Phone:631-741-8882
Practice Address - Fax:631-458-1426
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY212336OtherLICENSE