Basic Information
| Provider Information | |||||||||
| NPI: | 1326502907 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUBAY | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2155 STATE ROUTE 22B | ||||||||
| Address2: | |||||||||
| City: | MORRISONVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129623417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185638000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2155 STATE ROUTE 22B | ||||||||
| Address2: | |||||||||
| City: | MORRISONVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185638000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2019 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 274389 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.