Provider Demographics
NPI:1972089365
Name:SWARTZ, SHAUNTEL A (NPP)
Entity Type:Individual
Prefix:
First Name:SHAUNTEL
Middle Name:A
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3410
Mailing Address - Country:US
Mailing Address - Phone:518-463-8869
Mailing Address - Fax:518-270-2707
Practice Address - Street 1:1641 3RD ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144
Practice Address - Country:US
Practice Address - Phone:518-270-2800
Practice Address - Fax:518-270-2723
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY661414-1163W00000X
NY341852363LF0000X
NYF402615-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily