Provider Demographics
NPI:1669162558
Name:BELLANTON, LATASHA
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:
Last Name:BELLANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 BROADWAY
Mailing Address - Street 2:STE N
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207
Mailing Address - Country:US
Mailing Address - Phone:509-768-2249
Mailing Address - Fax:
Practice Address - Street 1:418 BROADWAY
Practice Address - Street 2:STE N
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207
Practice Address - Country:US
Practice Address - Phone:509-768-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker