Provider Demographics
NPI:1992355325
Name:HARTER, SHIREEN SASAN (LPN)
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:SASAN
Last Name:HARTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5993 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:NY
Mailing Address - Zip Code:13034-4118
Mailing Address - Country:US
Mailing Address - Phone:315-246-5326
Mailing Address - Fax:
Practice Address - Street 1:5993 LAKE ST
Practice Address - Street 2:
Practice Address - City:CAYUGA
Practice Address - State:NY
Practice Address - Zip Code:13034-4118
Practice Address - Country:US
Practice Address - Phone:315-246-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317161-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse