Healthcare Provider Details

I. General information

NPI: 1528211687
Provider Name (Legal Business Name): DENISE MICHELLE SHY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2008
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LAKE AVE APT 1
ROCHESTER NY
14612-5559
US

IV. Provider business mailing address

185 KENWOOD DR N APARTMENT # 334
LEVITTOWN PA
19055-2448
US

V. Phone/Fax

Practice location:
  • Phone: 610-299-6510
  • Fax:
Mailing address:
  • Phone: 267-980-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN527229L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number868896
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: