Individual
MRS. SHELLY LYNN PETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
324 UNIVERSITY AVE FL 3, SYRACUSE, NY 13210-1811
(315) 362-2540
(315) 361-1786
Mailing address
324 UNIVERSITY AVE FL 3, SYRACUSE, NY 13210-1811
(315) 362-2540
(315) 671-1786
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
402033
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402033
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04532216
—
NY
Enumeration date
08/06/2016
Last updated
02/16/2024
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