Provider Demographics
NPI:1316642614
Name:KELLY, SHARON (FNP-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E. GENESEE STREET
Mailing Address - Street 2:STE 500
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-471-8388
Mailing Address - Fax:315-471-8019
Practice Address - Street 1:1000 E. GENESEE STREET
Practice Address - Street 2:STE 500
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-471-8388
Practice Address - Fax:315-471-8019
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF03230462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily