Healthcare Provider Details

I. General information

NPI: 1710909056
Provider Name (Legal Business Name): IVY SHELBY R.N., F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MOUNT HOPE AVE
ROCHESTER NY
14620-2251
US

IV. Provider business mailing address

56 CONTINENTAL DR
ROCHESTER NY
14618-2006
US

V. Phone/Fax

Practice location:
  • Phone: 585-546-8400
  • Fax:
Mailing address:
  • Phone: 585-256-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332216-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: