Individual
STACY SHOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-7231
Mailing address
750 EAST ADAMS ST, SYRACUSE, NY 13210-2306
(315) 464-5294
(315) 464-5294
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
16823
CA
363LP0200X
Pediatric Nurse Practitioner
Primary
382505
NY
363LP0200X
Pediatric Nurse Practitioner
990023
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04523066
—
NY
05
—
79032273
—
CO
Enumeration date
12/31/2007
Last updated
11/25/2024
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