MEDICARE: IVY SHELBY R.N., F.N.P.

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	F332216-1	NY

General Provider Information

NPI Number	:	1710909056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY SHELBY R.N., F.N.P.

Provider Business Mailing Address
First Line	:	56 CONTINENTAL DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-2006
Country	:	US
Telephone Number	:	585-256-1284
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 MOUNT HOPE AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-2251
Country	:	US
Telephone Number	:	585-546-8400
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	07/08/2007

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