=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346110061
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRANVERA SHTETO NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2025
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 214 KING ST STE A
-----------------------------------------------------
City | OGDENSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13669-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-713-6765
-----------------------------------------------------
Fax | 866-208-0207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 214 KING ST STE A
-----------------------------------------------------
City | OGDENSBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13669-1142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-713-6765
-----------------------------------------------------
Fax | 866-208-0207
-----------------------------------------------------
=====================================================
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 | 358114
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------