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NPI Code Detail

MEDICARE: IVEY SHANIECE ROLON

MEDICARE: IVEY SHANIECE ROLON
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
1164W00000XLicensed Practical Nurse33256701NY

General Provider Information

NPI Number : 1508726829
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVEY SHANIECE ROLON
Provider Business Mailing Address
First Line : 107 ENDRES DR APT 5
Second Line :
City : MATTYDALE
State : NY
Zip : 13211-1131
Country : US
Telephone Number : 315-476-0600
Fax Number :
Provider Business Practice Location Address
First Line : 1011 W GENESEE ST STE 3
Second Line :
City : SYRACUSE
State : NY
Zip : 13204-2329
Country : US
Telephone Number : 315-476-0600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2025
Last Update Date : 11/18/2025

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Directions to “ IVEY SHANIECE ROLON ” Practice Location

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