Provider Demographics
NPI:1992580336
Name:BAXTRON, SHAMARRA
Entity type:Individual
Prefix:
First Name:SHAMARRA
Middle Name:
Last Name:BAXTRON
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 1:273 PULLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3426
Mailing Address - Country:US
Mailing Address - Phone:585-694-1667
Mailing Address - Fax:
Practice Address - Street 1:273 PULLMAN AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3426
Practice Address - Country:US
Practice Address - Phone:585-694-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344431-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse