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General NPI Number Information
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NPI Number | 1700061470
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Entity Type | Individual
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Provider Name | STACY SHOURT PNP
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Gender | Female
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2306
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Country | US
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Telephone | 315-464-7231
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Fax |
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Provider Business Mailing Address
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Address Line | 750 EAST ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2306
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Country | US
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Telephone | 315-464-5294
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Fax | 315-464-5294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 16823
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 990023
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 382505
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License Number State | NY
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