Individual
KRISTA MARIE SHANHOLTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, RN
Contact information
Practice address
90 PRESIDENTIAL PLZ, SYRACUSE, NY 13202-2240
(315) 464-4357
Mailing address
251 SALINA MEADOWS PKWY, STE 100, SYRACUSE, NY 13212-4516
(315) 464-2000
(315) 464-2010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
346664
NY
363L00000X
Nurse Practitioner
Primary
346664
NY
363LF0000X
Family Nurse Practitioner
346664
NY
Other
Enumeration date
09/29/2020
Last updated
11/18/2020
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