Provider Demographics
NPI:1386743318
Name:SECOR, SHARLYN ANN (NP)
Entity type:Individual
Prefix:
First Name:SHARLYN
Middle Name:ANN
Last Name:SECOR
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:811 RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2401
Mailing Address - Country:US
Mailing Address - Phone:585-671-4660
Mailing Address - Fax:585-671-4668
Practice Address - Street 1:811 RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2401
Practice Address - Country:US
Practice Address - Phone:585-671-4660
Practice Address - Fax:585-671-4668
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY333741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02555879Medicaid
NYJ4000302090Medicare PIN