Healthcare Provider Details

I. General information

NPI: 1538873674
Provider Name (Legal Business Name): SHANIA MARIE SHUSTER FNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANIA MARIE SHUSTER CNM, FNP

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 EIDER LANDING DR
CENTRAL SQUARE NY
13036-2470
US

IV. Provider business mailing address

26 EIDER LANDING DR
CENTRAL SQUARE NY
13036-2470
US

V. Phone/Fax

Practice location:
  • Phone: 315-559-2073
  • Fax:
Mailing address:
  • Phone: 315-559-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number349740
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: