Provider Demographics
NPI:1336421866
Name:SHATZKES, GAYLE LOREN
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:LOREN
Last Name:SHATZKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAY
Other - Middle Name:LOREN
Other - Last Name:SHATZKES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:109 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2209
Mailing Address - Country:US
Mailing Address - Phone:845-621-5555
Mailing Address - Fax:
Practice Address - Street 1:109 JONATHAN DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2209
Practice Address - Country:US
Practice Address - Phone:845-621-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440387-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health