Provider Demographics
NPI:1356891204
Name:SHAMBERGER, COLLEEN (RN, BSN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:SHAMBERGER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CORNELIUS AVENUE
Mailing Address - Street 2:HILLSIDE ELEMENTARY SCHOOL
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-377-1856
Mailing Address - Fax:518-377-1099
Practice Address - Street 1:1100 CORNELIUS AVE
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-5943
Practice Address - Country:US
Practice Address - Phone:518-377-1856
Practice Address - Fax:518-377-1099
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY460719-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool