Provider Demographics
NPI:1376026856
Name:GROSS, SHELBY LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:LYNN
Last Name:GROSS
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 1:963 PURDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-9016
Mailing Address - Country:US
Mailing Address - Phone:585-944-9092
Mailing Address - Fax:
Practice Address - Street 1:12 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:CANASERAGA
Practice Address - State:NY
Practice Address - Zip Code:14822-9721
Practice Address - Country:US
Practice Address - Phone:607-545-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY733443163W00000X
NYF354154-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse