Provider Demographics
NPI:1609822972
Name:SMITH, SHARON LORAINE (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LORAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7309 SENECA N MEDICAL OFFICE BULDG SUITE 109
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1312
Mailing Address - Country:US
Mailing Address - Phone:607-385-3700
Mailing Address - Fax:607-385-3600
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1933
Practice Address - Country:US
Practice Address - Phone:607-281-1970
Practice Address - Fax:607-281-1969
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331635363LF0000X
NYF331635-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01731933Medicaid
NY109466BFOtherPREFERRED CARE
500002120OtherMEDICARE PIN RAILROAD
NY005606041OtherBC/BS WNY
NYP019331635OtherBLUE CHOICE EXCELLUS