Provider Demographics
NPI:1093982183
Name:BOLANDER, SHAE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAE
Middle Name:LYNN
Last Name:BOLANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NEVIN
Other - Middle Name:SHAE
Other - Last Name:BOLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:
Practice Address - Street 1:33-57 HARRISON ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2107
Practice Address - Country:US
Practice Address - Phone:607-763-6412
Practice Address - Fax:607-763-5854
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55697-20207P00000X
NY299837207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine