Provider Demographics
NPI:1265670137
Name:SHADE, CHRISTINE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:SHADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:DARLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3005
Mailing Address - Country:US
Mailing Address - Phone:585-461-0410
Mailing Address - Fax:585-461-0601
Practice Address - Street 1:301 WEST AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1522
Practice Address - Country:US
Practice Address - Phone:585-523-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335765363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03339508Medicaid
NY03339508Medicaid
NYJ400086135/GP 70008AMedicare PIN