1467680702 NPI number — MRS. SHANTE DENISE STANBURY LPN

Table of content: MRS. SHANTE DENISE STANBURY LPN (NPI 1467680702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467680702 NPI number — MRS. SHANTE DENISE STANBURY LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STANBURY
Provider First Name:
SHANTE
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORANGE
Provider Other First Name:
SHANTE
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467680702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 BIDWELL TERRACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-694-2426
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
567 MIMOSA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-899-3571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  264731-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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