Provider Demographics
NPI:1083873947
Name:SIXT, SHELLEY A (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:SIXT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:A
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1565 LONG POND RD
Mailing Address - Street 2:CHEMICAL DEPENDENCY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7723
Mailing Address - Fax:585-723-7074
Practice Address - Street 1:1565 LONG POND RD
Practice Address - Street 2:CHEMICAL DEPENDENCY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7723
Practice Address - Fax:585-723-7074
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333759363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily