Provider Demographics
NPI:1851388102
Name:KINNEY, SHARLENE M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:M
Last Name:KINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 WHIG ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:13811-2510
Mailing Address - Country:US
Mailing Address - Phone:607-725-5634
Mailing Address - Fax:
Practice Address - Street 1:786 WHIG ST
Practice Address - Street 2:
Practice Address - City:NEWARK VALLEY
Practice Address - State:NY
Practice Address - Zip Code:13811
Practice Address - Country:US
Practice Address - Phone:607-725-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02222439Medicaid
H16885Medicare UPIN
NYCC2537Medicare ID - Type Unspecified