Healthcare Provider Details

I. General information

NPI: 1659955649
Provider Name (Legal Business Name): SHANNON PATRICIA OPPERMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-1834
US

IV. Provider business mailing address

336 ROBERTSON RD
SHERRILL NY
13461-1367
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF345911-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: