Provider Demographics
NPI:1447522875
Name:MCELWAIN, SHAWNA LYNN
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:LYNN
Last Name:MCELWAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16603 MUNGER RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:NY
Mailing Address - Zip Code:14422-9403
Mailing Address - Country:US
Mailing Address - Phone:585-966-3005
Mailing Address - Fax:
Practice Address - Street 1:120 ISLAND COTTAGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-3626
Practice Address - Country:US
Practice Address - Phone:585-966-3005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297460164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse