Healthcare Provider Details

I. General information

NPI: 1679065312
Provider Name (Legal Business Name): SHAWNA TRUDEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N UNION ST
OLEAN NY
14760-2736
US

IV. Provider business mailing address

135 N UNION ST
OLEAN NY
14760-2736
US

V. Phone/Fax

Practice location:
  • Phone: 716-375-7500
  • Fax:
Mailing address:
  • Phone: 716-375-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number718558
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number351186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: