Provider Demographics
NPI:1760160386
Name:ZACCARIA, ELENOR SHANNON (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ELENOR
Middle Name:SHANNON
Last Name:ZACCARIA
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:ELENOR
Other - Middle Name:SHANNON
Other - Last Name:ZACCARIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:1680 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2730
Mailing Address - Country:US
Mailing Address - Phone:716-908-3265
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily