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General NPI Number Information
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NPI Number | 1477900926
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Entity Type | Organization
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Legal Business Name | SHANNON BLAKE
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Dates
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Enumeration Date | 05/14/2016
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Last Update Date | 05/14/2016
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Provider Practice Location Address
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Address Line | 55 N EXCHANGE ST
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City | GENEVA
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State | NY
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Zip | 14456-1237
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Country | US
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Telephone | 585-362-9435
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Fax |
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Provider Business Mailing Address
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Address Line | 55 N EXCHANGE ST
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City | GENEVA
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State | NY
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Zip | 14456-1237
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RN
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Name | SHANNON BLAKE
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Credential |
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Telephone | 585-362-9435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number | 675121-1
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License Number State | NY
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