Shourt, Stacy

Shourt, Stacy is an individual health care provider with primary practice located at 750 E Adams St , Syracuse NY 13210-2306. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Shourt, Stacy can be contacted via phone (315) 464-7231.

Contact Information

Primary practice address
750 E Adams St Syracuse NY 13210-2306
Phone: (315) 464-7231
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 16823 California
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 990023 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X F382505 New York

Profile Details

NPI number 1700061470
LBN Legal business name Shourt, Stacy
Credentials Pediatric Nurse Practitioner (PNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 31st, 2007
Last updated Mar 6th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700061470 NPPES
Colorado MEDICAID 79032273

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