MEDICARE: SHAINA IRAIDA PIERRE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	350333	NY

General Provider Information

NPI Number	:	1386354785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAINA IRAIDA PIERRE FNP

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:	518-649-4094

Provider Business Practice Location Address
First Line	:	53 COLUMBIA ST
Second Line	:
City	:	RENSSELAER
State	:	NY
Zip	:	12144-2933
Country	:	US
Telephone Number	:	518-434-2526
Fax Number	:	518-434-2595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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