Individual
MARY SHALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4102 OLD VESTAL RD, VESTAL, NY 13850-3531
(607) 798-5692
Mailing address
4102 OLD VESTAL RD, VESTAL, NY 13850-3531
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
300636
NY
Other
Enumeration date
02/16/2011
Last updated
02/16/2011
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