Shawna Sierra Galloway, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

273010 Issued in NY

Practice address

611 W Main St
Watertown, NY 13601-1337

Phone

(315) 788-1530

NPI assigned

Nov 8, 2023

Reactivated

Aug 30, 2024

Sex

Female

Sole proprietor

No

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

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Thrive Wellness and Recovery, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Watertown, NY
  • NPI 1659389021
  NPD
• Citizen Advocates, Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Malone, NY
  • NPI 1780619064
  NPD (past)

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

{
    "created_epoch": "1699401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1891569166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 S MAIN ST",
            "city": "BLACK RIVER",
            "state": "NY",
            "postal_code": "136123135",
            "telephone_number": "315-489-9137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W MAIN ST",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136011337",
            "telephone_number": "315-788-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLOWAY",
        "first_name": "SHAWNA",
        "middle_name": "SIERRA",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-08",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "deactivation_date": "2024-02-01",
        "reactivation_date": "2024-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "273010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Gabriel, LICENSED MARRIAGE AN
• Mary Ellen Gagnon, LPN
• Elisabeth Gahler, PT
• Robin D Gaines, R.N.
• Brandi Lee Gallo, PRS/PSR
• Sandra Yvonne Gantt, LPN
• Hiram Amado Garcia Rivera, D.M.D
• Randy Gardner, CASAC
• Anna Elizabeth Garrabrant, MSN, APRN, FNP-BC
• James Garrison

• Licensed Practical Nurse in Watertown, NY
• Providers in Watertown, 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 Oct 15, 2024; 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.