Provider Demographics
NPI:1326034752
Name:WOJTASZCZYK, SHELLEY JAKEMAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:JAKEMAN
Last Name:WOJTASZCZYK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7311 NORTHWOODS RD
Mailing Address - Street 2:
Mailing Address - City:ARCADE
Mailing Address - State:NY
Mailing Address - Zip Code:14009-9530
Mailing Address - Country:US
Mailing Address - Phone:585-496-2075
Mailing Address - Fax:
Practice Address - Street 1:3435 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1145
Practice Address - Country:US
Practice Address - Phone:716-835-2966
Practice Address - Fax:716-834-3901
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331617-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01705339Medicaid
NYBB1412Medicare UPIN