Provider Demographics
NPI:1588392930
Name:NYE, SHAWNNA ANN (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SHAWNNA
Middle Name:ANN
Last Name:NYE
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:98 N 2ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1254
Mailing Address - Country:US
Mailing Address - Phone:315-668-1202
Mailing Address - Fax:315-668-5268
Practice Address - Street 1:98 N 2ND ST STE 101
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1254
Practice Address - Country:US
Practice Address - Phone:315-668-1202
Practice Address - Fax:315-668-5268
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349657207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine