Mandeville, Shirley S
Mandeville, Shirley S is an individual health care provider with primary practice located at 601 Elmwood Ave Box Surg, Rochester NY 14642-1413. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Mandeville, Shirley S can be contacted via phone (585) 276-3332.Contact Information
Primary practice address
601 Elmwood Ave Box Surg
Rochester NY 14642-1413
Phone: (585) 276-3332
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | F331695-1 | New York |
Profile Details
| NPI number | 1538113816 |
|---|---|
| LBN Legal business name | Mandeville, Shirley S |
| Credentials | Family Nurse Practitioner (FNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 20th, 2006 |
| Last updated | Jul 18th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538113816 | NPPES |
| New York | Other | 9512361 | INDEPENDENT HEALTH |
| New York | MEDICAID | 01791166 | INDEPENDENT HEALTH |
| New York | Other | P019331695 | INDEPENDENT HEALTH |
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