Provider Demographics
NPI:1710027966
Name:SHEHU, NANCY L (LPN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:SHEHU
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 1:9 EDEN DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-9455
Mailing Address - Country:US
Mailing Address - Phone:607-838-8920
Mailing Address - Fax:
Practice Address - Street 1:9 EDEN DR
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-9455
Practice Address - Country:US
Practice Address - Phone:607-838-8920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270409-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02349755Medicare ID - Type UnspecifiedMEDICAID BILLING ID