Provider Demographics
NPI:1063259497
Name:DURANT, SHAWN ANTHONY
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:ANTHONY
Last Name:DURANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PROSPECT HILL ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:PINE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12567-5307
Mailing Address - Country:US
Mailing Address - Phone:845-416-8673
Mailing Address - Fax:
Practice Address - Street 1:1 COLUMBIA ST STE 200
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3924
Practice Address - Country:US
Practice Address - Phone:845-473-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311891363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health