Provider Demographics
NPI:1215381629
Name:BREU, SHANNON LEE (LPN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:BREU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:BREU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:22 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487-9780
Mailing Address - Country:US
Mailing Address - Phone:585-346-9668
Mailing Address - Fax:
Practice Address - Street 1:22 BRANCH ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:NY
Practice Address - Zip Code:14487-9780
Practice Address - Country:US
Practice Address - Phone:585-346-9668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294009-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse