Provider Demographics
NPI:1588741599
Name:GIBSON, SHELLEY (FNP-BC, APRN)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BOSTON POST RD
Mailing Address - Street 2:MINUTE CLINIC INSIDE CVS/PHARMACY #1949
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3905
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:1310 BOSTON POST RD
Practice Address - Street 2:MINUTECLINIC INSIDE CVS/PHARMACY #1949
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3905
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR52086363L00000X
NYF337709-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner