Provider Demographics
NPI:1477948123
Name:SHOESMITH, AMY (MS, FNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:
Last Name:SHOESMITH
Suffix:
Gender:F
Credentials:MS, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 RTE 23A
Mailing Address - Street 2:
Mailing Address - City:TANNERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12485
Mailing Address - Country:US
Mailing Address - Phone:518-589-6843
Mailing Address - Fax:518-943-4437
Practice Address - Street 1:6171 RTE 23A
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12485
Practice Address - Country:US
Practice Address - Phone:518-589-6843
Practice Address - Fax:518-943-4437
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626609163W00000X
NYF339344-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse