Provider Demographics
NPI:1851669683
Name:CHAN, SHAWNA (LPN)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:CHAN
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 1:7 ONEIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1134
Mailing Address - Country:US
Mailing Address - Phone:917-349-7978
Mailing Address - Fax:
Practice Address - Street 1:7 ONEIDA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1134
Practice Address - Country:US
Practice Address - Phone:917-349-7978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753022163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse