Provider Demographics
NPI:1689921942
Name:STEEPROCK, SHELLEY DAWN (FNP)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:DAWN
Last Name:STEEPROCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:NY
Mailing Address - Zip Code:14081-9531
Mailing Address - Country:US
Mailing Address - Phone:716-549-0861
Mailing Address - Fax:
Practice Address - Street 1:845 RTES 5 & 20
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:NY
Practice Address - Zip Code:14081-9716
Practice Address - Country:US
Practice Address - Phone:716-951-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332385363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily