Provider Demographics
NPI:1013110964
Name:BYER, SHIRLEY ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:BYER
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 1:100 RANDALL AVE
Mailing Address - Street 2:1 H
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-2751
Mailing Address - Country:US
Mailing Address - Phone:516-208-8236
Mailing Address - Fax:
Practice Address - Street 1:100 RANDALL AVE
Practice Address - Street 2:1 H
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-2751
Practice Address - Country:US
Practice Address - Phone:516-208-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057193164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02106398Medicaid