Provider Demographics
NPI:1386257707
Name:DRURY, SHANTEL
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:
Last Name:DRURY
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 1:4069 COUNTY ROAD 15A
Mailing Address - Street 2:
Mailing Address - City:ANGELICA
Mailing Address - State:NY
Mailing Address - Zip Code:14709-8730
Mailing Address - Country:US
Mailing Address - Phone:607-590-7022
Mailing Address - Fax:
Practice Address - Street 1:4069 COUNTY ROAD 15A
Practice Address - Street 2:
Practice Address - City:ANGELICA
Practice Address - State:NY
Practice Address - Zip Code:14709-8730
Practice Address - Country:US
Practice Address - Phone:607-590-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336836-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse