Provider Demographics
NPI:1801833181
Name:DUANE, SHIRLEY (NP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DUANE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 ABBOTT RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2039
Mailing Address - Country:US
Mailing Address - Phone:716-828-7000
Mailing Address - Fax:716-651-9855
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-828-7000
Practice Address - Fax:716-651-9855
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332061363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051004000046OtherFIDELIS
NY9512974OtherIHA
NY00027270401OtherUNIVERA
NY173297BJOtherPREFERRED CARE
NY01856519Medicaid
NY000560318006OtherBC/BS
NY000560318006OtherBC/BS
NY173297BJOtherPREFERRED CARE
RA8306Medicare ID - Type Unspecified