Provider Demographics
NPI:1093489833
Name:ROLOFF, SHAUNA MARIE (NPP)
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:MARIE
Last Name:ROLOFF
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FELLOWS AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3107
Mailing Address - Country:US
Mailing Address - Phone:678-662-4247
Mailing Address - Fax:
Practice Address - Street 1:146 BARRETT ST STE 2
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2004
Practice Address - Country:US
Practice Address - Phone:518-952-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403601363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06772370Medicaid