Provider Demographics
NPI:1790918118
Name:SALERNO, SHIRLEY KATHRYN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:KATHRYN
Last Name:SALERNO
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 5
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0005
Mailing Address - Country:US
Mailing Address - Phone:518-480-3129
Mailing Address - Fax:
Practice Address - Street 1:23 ROSE LN
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-8850
Practice Address - Country:US
Practice Address - Phone:518-480-3129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251620-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse