Individual
SHAWN-AMY RAE BAZARGAN-LARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
475 WATERVLIET SHAKER RD, LATHAM, NY 12110-4622
(518) 785-1341
Mailing address
91 FIDDLERS LN, LATHAM, NY 12110-5343
(518) 785-8591
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
511807
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03052893
—
NY
Enumeration date
03/20/2019
Last updated
03/20/2019
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