Provider Demographics
NPI:1104433499
Name:BENTLEY, SHANNON MARIE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MARIE
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1721
Mailing Address - Country:US
Mailing Address - Phone:716-884-0230
Mailing Address - Fax:716-332-3543
Practice Address - Street 1:2550 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1721
Practice Address - Country:US
Practice Address - Phone:716-884-0230
Practice Address - Fax:716-332-3543
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF346361-01363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner