SHANE M SOPP


Address: 4900 Broad Rd, Cgh Pob Suite 2v, Syracuse, NY 13215-2265
Phone: 3154925005

SHANE M SOPP (NPI# 1497741243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1497741243
Entity Type Individual
Full Name SHANE M SOPP
Credential MD
Practice Address 4900 Broad Rd
Cgh Pob Suite 2v
Syracuse
NY 13215-2265
Mailing Address Po Box 2003
East Syracuse
NY 13057-4503
Practice Telephone 3154925005
Practice Fax Number 3154925324
Mailing Telephone 3154463904
Mailing Fax Number 3154452936
Enumeration Date 2005-09-26
Last Update Date 2012-06-18
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207VG0400X Obstetrics & Gynecology
Specialization: Gynecology
141803 NY Allopathic & Osteopathic Physicians

Office Location

Street Address 4900 BROAD RD
CGH POB SUITE 2V
City SYRACUSE
State NY
Zip Code 13215-2265

Providers in the same location

NPI Name Taxonomy Address Enumeration
1336143221 David C Canfield Anesthesiology 4900 Broad Rd, Syracuse, NY 13215-2265 2005-06-08
1205474335 Meaghan Porter Physical Therapist 4900 Broad Rd, Syracuse, NY 13215-2265 2019-12-19
1982262655 Ryan Christopher Staib Nurse Anesthetist, Certified Registered 4900 Broad Rd, Syracuse, NY 13215-2265 2019-05-29
1164989505 Jessica Detor Social Worker 4900 Broad Rd, Physician Office Building North 3n, Syracuse, NY 13215-2265 2019-02-21
1316402415 Oleksandr Kaplun Physician Assistant 4900 Broad Rd, Syracuse, NY 13215-2265 2019-02-04
1003390204 Ianna Javier Garcia Occupational Therapist 4900 Broad Rd, Syracuse, NY 13215-2265 2018-09-24
1194207241 Rebekah Schu Physician Assistant 4900 Broad Rd, Syracuse, NY 13215-2265 2018-09-05
1669990065 Katrina E Garrigan Physician Assistant 4900 Broad Rd, Syracuse, NY 13215-2265 2017-09-06
1336667948 Kristy Mcgough Physician Assistant 4900 Broad Rd, Syracuse, NY 13215-2265 2017-09-04
1285158402 Nicholas David Treinin Pharmacist 4900 Broad Rd, Syracuse, NY 13215-2265 2017-07-30
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1396367785 Jeffrey Alan Gaulrapp Registered Nurse Upstate University Hospital Community General Campus, 4900 Broad Road, Syracuse, NY 13215 2020-05-08
1134752454 Crystal Elizabeth Hoban Marriage & Family Therapist 4922 W. Seneca Turnpike, Syracuse, NY 13215 2020-02-14
1083004907 Roger G Levine Md Psychiatric Residential Treatment Facility 4914 West Seneca Turnpkie, Syracuse, NY 13215 2015-01-30
1558771071 Edleanna Robinson Licensed Practical Nurse 5075 W Seneca Turnpike, Syracuse, NY 13215 2014-05-06
1689013450 Rhonda Lee Philopena Emergency Medicine 4900 Broad Rd 1st Fl, Syracuse, NY 13215 2013-06-14
1962778498 Marie Anne Stevens Licensed Practical Nurse 4057 Seneca Tpk, Van Duyn Home and Hospital, Syracuse, NY 13215 2012-03-29
1033439088 Anna-marie Simpson Chiropractor 4922 W Seneca Tpke, Syracuse, NY 13215 2010-06-01
1992028690 A John Wylie Pharmacist 4840 Sherwood Dr., Syracuse, NY 13215 2010-03-09
1669616512 Asalim A Thabet Emergency Medicine 4900 Braod Rd, 1st Fl, Syracuse, NY 13215 2009-04-22
1992948707 Jesse Reed Gutnick Surgery 4900 Borad Rd, Suite 23 North, Syracuse, NY 13215 2009-04-08
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Taxonomy Information

Taxonomy Code 207VG0400X
Grouping Allopathic & Osteopathic Physicians
Classification Obstetrics & Gynecology
Specialization Gynecology

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1184971897 Beth Houck Md LLC Obstetrics & Gynecology 475 Irving Ave, Suite 406, Syracuse, NY 13210-1756 2012-08-13
1174711774 Nesim Contente Md PC Obstetrics & Gynecology 215 E Water St, Syracuse, NY 13202-1159 2007-10-09
1982813424 Comprehensive Gynecology, PC Obstetrics & Gynecology 770 James St Ste 100b, Syracuse, NY 13203-2642 2007-05-22
1942352836 Women's View Gynecology-closed Obstetrics & Gynecology 1200 E Genesee St, Suite 207, Syracuse, NY 13210-1968 2007-01-18
1821033556 Raja W Abdul-karim Obstetrics & Gynecology 90 Presidential Plz, 3rd Floor, Syracuse, NY 13202-2240 2006-06-17
1417908039 Kristen Kratzert Obstetrics & Gynecology 739 Irving Ave, Suite 530, Syracuse, NY 13210-1651 2006-05-16
1992765879 Fathi A Jishi Obstetrics & Gynecology 1000 E Genesee St, Ste 500, Syracuse, NY 13210 2006-03-24
1770562761 Melanie D Ramachandran Obstetrics & Gynecology 1101 Erie Blvd E, Ste 210, Syracuse, NY 13210-1144 2006-01-10
1952397705 Shane M Sopp, Md PC Obstetrics & Gynecology 4900 Broad Rd, Cgh Pob Suite 2v, Syracuse, NY 13215-2265 2005-09-26
1275535734 Stephen Mark Cohen Obstetrics & Gynecology 739 Irving Ave, Suite 530, Syracuse, NY 13210-1651 2005-08-15
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Competitor

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City SYRACUSE
Zip Code 13215

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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