Shanatha Crandall, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

326639 Issued in NY

Practice address

58 New Rd
Millport, NY 14864-9764

Phone

(607) 259-6495

Fax

(607) 398-2064

NPI assigned

Feb 15, 2021

Last updated

Feb 15, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1205429875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 NEW RD",
            "city": "MILLPORT",
            "state": "NY",
            "postal_code": "148649764",
            "telephone_number": "607-259-6495",
            "fax_number": "607-398-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 NEW RD",
            "city": "MILLPORT",
            "state": "NY",
            "postal_code": "148649764",
            "telephone_number": "607-259-6495",
            "fax_number": "607-398-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRANDALL",
        "first_name": "SHANATHA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-15",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "326639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josephine Detar, MD
• Tiffaney Aleyse Perry
• Mary Jo Mallory Rhodes, LPN

• Licensed Practical Nurse in Millport, NY
• Providers in Millport, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.