Provider Demographics
NPI:1710404009
Name:PIDKAMINY, SHELBIE FILICIA (MS, NP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHELBIE
Middle Name:FILICIA
Last Name:PIDKAMINY
Suffix:
Gender:F
Credentials:MS, NP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 HAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2323
Mailing Address - Country:US
Mailing Address - Phone:315-289-8850
Mailing Address - Fax:
Practice Address - Street 1:4914 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2374
Practice Address - Country:US
Practice Address - Phone:315-446-1435
Practice Address - Fax:315-446-4269
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704756163WP0200X
NY403022363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics