Provider Demographics
NPI:1255621231
Name:LACEY, SHAWNA (RN)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:LACEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 COUNTY ROUTE 34
Mailing Address - Street 2:
Mailing Address - City:EAST CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12060-2203
Mailing Address - Country:US
Mailing Address - Phone:518-821-7844
Mailing Address - Fax:
Practice Address - Street 1:12 METRO PARK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1139
Practice Address - Country:US
Practice Address - Phone:518-437-0152
Practice Address - Fax:518-437-0269
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541322163WC1600X, 163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health