Basic Information
| Provider Information | |||||||||
| NPI: | 1255094264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | SHAYNON | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 KINGS HWY S | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146175504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153592123 | ||||||||
| FaxNumber: | 3153592167 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 DRIVING PARK AVE | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145131090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153592123 | ||||||||
| FaxNumber: | 3153592167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2021 | ||||||||
| LastUpdateDate: | 10/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 310463 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.