Provider Demographics
NPI:1124331228
Name:FARRY, ANITA (FNP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:FARRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:SHACKELFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 3203
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-0203
Mailing Address - Country:US
Mailing Address - Phone:518-346-3100
Mailing Address - Fax:877-583-1284
Practice Address - Street 1:19 WHIPPLE WAY
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-9204
Practice Address - Country:US
Practice Address - Phone:518-346-3100
Practice Address - Fax:877-583-1284
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-17
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334137-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily