Healthcare Provider Details

I. General information

NPI: 1265318596
Provider Name (Legal Business Name): SHINELLE TYSON FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CARLISLE ST
NATRONA HEIGHTS PA
15065-1152
US

IV. Provider business mailing address

6301 RIVERDALE AVE
BRONX NY
10471-1046
US

V. Phone/Fax

Practice location:
  • Phone: 724-224-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberF356729-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: