Healthcare Provider Details

I. General information

NPI: 1982060059
Provider Name (Legal Business Name): DANIEL PAUL SHOOTS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 OAKWOOD EST
DUNDEE NY
14837-1153
US

IV. Provider business mailing address

6 OAKWOOD EST
DUNDEE NY
14837-1153
US

V. Phone/Fax

Practice location:
  • Phone: 315-521-1866
  • Fax:
Mailing address:
  • Phone: 315-521-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number704976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: