Healthcare Provider Details

I. General information

NPI: 1497838502
Provider Name (Legal Business Name): BEVERLY SHAHEEN MSNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 RIDGE RD W BUILDING D
ROCHESTER NY
14626-3249
US

IV. Provider business mailing address

3101 RIDGE RD W BUILDING D
ROCHESTER NY
14626-3249
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-1580
  • Fax: 585-225-3137
Mailing address:
  • Phone: 585-225-1580
  • Fax: 585-225-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF420136-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: