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General NPI Number Information
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NPI Number | 1861356826
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Entity Type | Individual
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Provider Name | SHAWN MICHAEL LAVALLEY
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Gender | Male
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 3178 PLANK RD
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City | MINEVILLE
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State | NY
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Zip | 12956-1051
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Country | US
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Telephone | 518-791-5179
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Fax |
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Provider Business Mailing Address
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Address Line | 3178 PLANK RD
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City | MINEVILLE
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State | NY
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Zip | 12956-1051
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Country | US
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Telephone | 518-791-5179
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | 651720417
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License Number State | NY
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