Provider Demographics
NPI:1447553094
Name:LAFAVE, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:LAFAVE
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 1:2025 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-4731
Mailing Address - Country:US
Mailing Address - Phone:312-245-1490
Mailing Address - Fax:
Practice Address - Street 1:228 EIGHT AVE
Practice Address - Street 2:
Practice Address - City:SYLVAN BEACH
Practice Address - State:NY
Practice Address - Zip Code:13157
Practice Address - Country:US
Practice Address - Phone:315-762-0146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225884-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse