Most Relevant Information
Provider Data
| NPI Number: | 1003376898 |
| Provider Name: | SHAWN-AMY RAE BAZARGAN-LARI REGISTERED NURSE |
| Entity Type: | Individual |
| Taxonomy Code: | 163WS0200X |
| Specialty: | Registered Nurse |
| License Number: | 511807 |
Most Important Dates
| Enumeration Date: | 03/20/2019 |
| Last Updated: | 03/20/2019 |
Provider Practice Location
475 WATERVLIET SHAKER RD
LATHAM
NY
121104622
Practice Location Phone/Fax
| Phone: | 5187851341 |
| Fax: |
Provider Mailing Location
91 FIDDLERS LN
LATHAM
NY
121105343
Provider Mailing Phone/Fax
| Phone: | 5187858591 |
| Fax: |