Provider Demographics
NPI:1689727711
Name:HARRIS EL, SHANTEASHIA
Entity Type:Individual
Prefix:
First Name:SHANTEASHIA
Middle Name:
Last Name:HARRIS EL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2929
Mailing Address - Country:US
Mailing Address - Phone:585-546-2771
Mailing Address - Fax:585-454-7001
Practice Address - Street 1:1120 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1912
Practice Address - Country:US
Practice Address - Phone:315-475-5540
Practice Address - Fax:315-475-5554
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily