Provider Demographics
NPI:1366244527
Name:BLAGROVE CARTY, SHALANE SHANTEL (LPN)
Entity type:Individual
Prefix:
First Name:SHALANE
Middle Name:SHANTEL
Last Name:BLAGROVE CARTY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 OAK ST
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-3218
Mailing Address - Country:US
Mailing Address - Phone:516-360-6732
Mailing Address - Fax:
Practice Address - Street 1:1115 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5019
Practice Address - Country:US
Practice Address - Phone:718-717-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352133164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse