Healthcare Provider Details

I. General information

NPI: 1710404009
Provider Name (Legal Business Name): SHELBIE FILICIA PIDKAMINY MS, NP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 11/27/2023
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 W GENESEE ST
CAMILLUS NY
13031-2374
US

IV. Provider business mailing address

213 HAYWOOD RD
SYRACUSE NY
13219-2323
US

V. Phone/Fax

Practice location:
  • Phone: 315-446-1435
  • Fax: 315-446-4269
Mailing address:
  • Phone: 315-289-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number704756
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number403022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: