Provider Demographics
NPI:1720331127
Name:BELLATERRA, SHOSHANAH CERES (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHOSHANAH
Middle Name:CERES
Last Name:BELLATERRA
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:PO BOX 5524
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-0524
Mailing Address - Country:US
Mailing Address - Phone:518-788-2463
Mailing Address - Fax:
Practice Address - Street 1:1425 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2702
Practice Address - Country:US
Practice Address - Phone:518-788-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse