Healthcare Provider Details

I. General information

NPI: 1134636459
Provider Name (Legal Business Name): SHAY LEIGH TENNY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASHINGTON ST
ELMIRA NY
14901-2849
US

IV. Provider business mailing address

23 PARK LN
BIG FLATS NY
14814-7953
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-4700
  • Fax:
Mailing address:
  • Phone: 607-738-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number605404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: