Healthcare Provider Details

I. General information

NPI: 1255621231
Provider Name (Legal Business Name): SHAWNA LACEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 METRO PARK RD SUITE 102
ALBANY NY
12205-1139
US

IV. Provider business mailing address

96 COUNTY ROUTE 34
EAST CHATHAM NY
12060-2203
US

V. Phone/Fax

Practice location:
  • Phone: 518-437-0152
  • Fax: 518-437-0269
Mailing address:
  • Phone: 518-821-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number541322
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number541322
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number541322
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: