Provider Demographics
NPI:1497106447
Name:KEENE, SHELLEY (NP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:KEENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:EISENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:62 CAPE HENRY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9692
Mailing Address - Country:US
Mailing Address - Phone:585-260-8797
Mailing Address - Fax:
Practice Address - Street 1:1183 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1662
Practice Address - Country:US
Practice Address - Phone:585-256-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667426163W00000X
NY344429363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05737426Medicaid