=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285301465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY R SHELDON FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2021
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1982 OLD ROUTE 17
-----------------------------------------------------
City | ROSCOE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12776-5200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-498-4800
-----------------------------------------------------
Fax | 607-498-5455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 TITUS PLACE
-----------------------------------------------------
City | WALTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13856-1455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-865-2400
-----------------------------------------------------
Fax | 607-865-7305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 348214
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------