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General NPI Number Information
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NPI Number | 1902537038
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Entity Type | Individual
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Provider Name | LACEY E SHAMBO DNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 18983 US ROUTE 11
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City | WATERTOWN
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State | NY
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Zip | 13601-5320
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Country | US
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Telephone | 315-782-0059
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Fax |
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Provider Business Mailing Address
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Address Line | 15895 HAMP RD
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City | WATERTOWN
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State | NY
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Zip | 13601-6768
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Country | US
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Telephone | 315-523-1499
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TPAN2536
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1169690
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 689095
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | LG-0012858
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License Number State | DE
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 350243
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.1000145-NP
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License Number State | CO
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10042097
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License Number State | OR
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Taxonomy #8
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4036258
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License Number State | KY
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