Provider Demographics
NPI:1679716468
Name:MULPAGANO, SHAUNA MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:SHAUNA
Middle Name:MARIE
Last Name:MULPAGANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:MULPAGANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:5093 CLIFTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2637
Mailing Address - Country:US
Mailing Address - Phone:315-458-9257
Mailing Address - Fax:
Practice Address - Street 1:23 1ST STREET
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031
Practice Address - Country:US
Practice Address - Phone:315-672-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296231-1164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse