Shawn-Amy Rae Bazargan-Lari, REGISTERED NURSE
Individual provider Active NPI School Registered Nurse · Latham, NY
NPI 1003376898 · NPPES record last updated Mar 20, 2019
Key facts
- NPI
- 1003376898
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Registered Nurse 163WS0200X
- License
- 511807 (NY)
- Practice address
- 475 Watervliet Shaker Rd
Latham, NY 12110-4622 - Phone
- (518) 785-1341
- NPI assigned
- Mar 20, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 511807 | NY | MD | School Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North Colonie Central School District | School | Past |
Accepting new patients |
| North Colonie Central School District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 511807 | NY | Yes |
Addresses
Primary practice location
475 Watervliet Shaker Rd
Latham, NY 12110-4622
Mailing address
91 Fiddlers LN
Latham, NY 12110-5343
Phone (518) 785-8591
Other practice location 1
30 Southgate Rd
Loudonville, NY 12211-1132
Phone (518) 785-6607 ext. 4210
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03052893 | Medicaid | NY |
Other providers in Latham, NY
- Brent Jude Bashaw
- Dominique Bassallo
- Lisa Battisti
- Richard T Bauer III
- Preeti Bavdekar
- Ellen Weybright Beals
- William J Bean Sr.
- Silvia Y Beaupre
- Kathryn Beauvais
- Christine Beberwyk
All providers in Latham, NY · School Registered Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.