Provider Demographics
NPI:1467264234
Name:MCCULLERS, SHAWNDARIE DIANE (RN)
Entity type:Individual
Prefix:MRS
First Name:SHAWNDARIE
Middle Name:DIANE
Last Name:MCCULLERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 AMHERSTDALE RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4415
Mailing Address - Country:US
Mailing Address - Phone:716-225-7879
Mailing Address - Fax:
Practice Address - Street 1:179 AMHERSTDALE RD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226-4415
Practice Address - Country:US
Practice Address - Phone:716-225-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY945833-01163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical