Provider Demographics
NPI:1932328887
Name:LLOYD, SHANNON C (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:C
Last Name:LLOYD
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 1:3073 YORTON RD
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-4511
Mailing Address - Country:US
Mailing Address - Phone:315-480-2529
Mailing Address - Fax:
Practice Address - Street 1:3073 YORTON RD
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-4511
Practice Address - Country:US
Practice Address - Phone:315-697-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278429-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02603107Medicaid