Provider Demographics
NPI:1326502907
Name:DUBAY, SHAWN (LPN, RN)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:DUBAY
Suffix:
Gender:
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 TOM MILLER RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6401
Mailing Address - Country:US
Mailing Address - Phone:518-534-8874
Mailing Address - Fax:
Practice Address - Street 1:15 BROAD ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3463
Practice Address - Country:US
Practice Address - Phone:518-563-6800
Practice Address - Fax:518-563-6800
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY903943163WS0200X, 163W00000X
NY274389164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No164W00000XNursing Service ProvidersLicensed Practical Nurse