Provider Demographics
NPI:1720045065
Name:PACE, SHEILA M (CNM, NP)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:PACE
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:520 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1304
Practice Address - Country:US
Practice Address - Phone:716-656-4077
Practice Address - Fax:716-322-7685
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0002631367A00000X
NY421026363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01480148Medicaid
NYJ400023263Medicare PIN
R99294Medicare UPIN
NY159951CQOtherPREFERRED CARE #
NY5090673OtherIHA #
NYDD4420Medicare ID - Type Unspecified
RB8239Medicare PIN