Provider Demographics
NPI:1891100756
Name:MCSHANE, DANINE (NP)
Entity Type:Individual
Prefix:
First Name:DANINE
Middle Name:
Last Name:MCSHANE
Suffix:
Gender:F
Credentials:NP
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 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29 JONES AVENUE - CHATHAM MEDICAL BLDG
Practice Address - Street 2:CHATHAM INTERNAL MEDICINE
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1136
Practice Address - Country:US
Practice Address - Phone:518-392-8600
Practice Address - Fax:518-392-8601
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306914363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03884599Medicaid
NY03884599Medicaid