Provider Demographics
NPI:1538873674
Name:SHUSTER, SHANIA MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHANIA
Middle Name:MARIE
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:SHANIA
Other - Middle Name:MARIE
Other - Last Name:GUSHLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:8125 CICERO MILLS RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-7315
Mailing Address - Country:US
Mailing Address - Phone:315-559-2073
Mailing Address - Fax:
Practice Address - Street 1:6800 E GENESEE ST STE 1501
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1097
Practice Address - Country:US
Practice Address - Phone:315-445-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine