Healthcare Provider Details

I. General information

NPI: 1306761762
Provider Name (Legal Business Name): MRS. SHANA SWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 FISHERS STATION DR STE 130
VICTOR NY
14564-9744
US

IV. Provider business mailing address

8430 GREEN RD
DANSVILLE NY
14437-9140
US

V. Phone/Fax

Practice location:
  • Phone: 585-924-7207
  • Fax:
Mailing address:
  • Phone: 607-281-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: