Provider Demographics
NPI:1053587162
Name:KLEIN, SHAWN MARY (LPN)
Entity type:Individual
Prefix:MISS
First Name:SHAWN
Middle Name:MARY
Last Name:KLEIN
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 1:9153 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9547
Mailing Address - Country:US
Mailing Address - Phone:585-345-4371
Mailing Address - Fax:
Practice Address - Street 1:9153 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9547
Practice Address - Country:US
Practice Address - Phone:585-345-4371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266282164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse