Provider Demographics
NPI:1194781658
Name:SHAHEEN, NANCY ANN (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 GENESEE ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-624-6116
Practice Address - Fax:315-624-6318
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2095802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01885469Medicaid
NY040426014048OtherFIDELIS
NY10047014OtherCDPHP
NY209580-1OtherWC
NY9607833OtherMVP
NYP010209580OtherBCBS
NY300085250OtherRAIL ROAD MEDICARE
NY41996114OtherGHI
NY01647929Medicaid
NY01885469Medicaid