Organization
VILLAGE OF FAYETTEVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN SHEPARDSON (VILLAGE CLERK - TREASURER)
(315) 637-9864
Entity
Organization
Contact information
Practice address
425 E GENESSE ST, FAYETTEVILLE, NY 13066
(315) 637-9864
(315) 637-0106
Mailing address
PO BOX 535, BALDWINSVILLE, NY 13027-0535
(315) 635-1789
(315) 635-3289
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02377402
—
NY
01
—
P00048271
RAILROAD MEDICARE
NY
Enumeration date
10/10/2005
Last updated
12/31/2025
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