Individual
SHANAMAE VICTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
1 ATWELL RD, COOPERSTOWN, NY 13326-1301
(607) 547-6982
Mailing address
73 WILKINS AVE, ALBANY, NY 12206-3250
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
018165
NY
Other
Enumeration date
10/15/2014
Last updated
10/15/2014
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