Provider Demographics
NPI:1295165041
Name:FEDYSHYN, CORTNEY (FNP-C)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:FEDYSHYN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRISTOL LANE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731
Mailing Address - Country:US
Mailing Address - Phone:941-952-8090
Mailing Address - Fax:
Practice Address - Street 1:271 GRANT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1407
Practice Address - Country:US
Practice Address - Phone:315-704-6097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1013558363LF0000X
NY339601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily