MRS. SHELLY LYNN PETERS (NPI# 1942754015) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942754015 |
| Entity Type | Individual |
| Full Name | MRS. SHELLY LYNN PETERS |
| Other Name | SHELLY LYNN PANGBURN |
| Credential | NP |
| Practice Address |
329 N. Salina Street Helio Health Syracuse NY 13203 |
| Mailing Address |
4736 Onondaga Blvd Syracuse NY 13219-3304 |
| Practice Telephone | 3154711564 |
| Practice Fax Number | 3154712531 |
| Mailing Telephone | 3153800728 |
| Enumeration Date | 2016-08-06 |
| Last Update Date | 2019-03-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 402033 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
402033 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 04532216 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4736 Onondaga Blvd, Pmb 403, Syracuse, NY 13219 | 3153800728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194199273 | Shelly Peters | Massage Therapist | 9750 Cuyamaca St, 101, Santee, CA 92071-2626 | 2015-11-30 |
| 1346862992 | Shelly Peters | Case Manager/Care Coordinator | 445 E Dublin Granville Rd, Worthington, OH 43085-3192 | 2020-05-16 |
| 1720593015 | Shelly Peters | Dental Hygienist | 500 Kennedy Dr, Rangely, CO 81648-3502 | 2017-12-07 |
| Street Address |
329 N. SALINA STREET HELIO HEALTH |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13203 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659998193 | Allison Elizabeth Mills | Social Worker | 1045 James St., Syracuse, NY 13203 | 2020-07-01 |
| 1467004333 | Humanitarian Organization for Multicultural Experiences, Inc. | Psychologist | 831 James Street, Syracuse, NY 13203 | 2019-07-11 |
| 1215405287 | Wellness Therapy Services Lcsw, Pllc | Counselor | Wellness Therapy Services Lcsw, Pllc, 404 Oak St. #200, Syracuse, NY 13203 | 2018-11-08 |
| 1962904912 | Michael Musante | Developmental Therapist | 1045 James Streret, Syracuse, NY 13203 | 2018-03-06 |
| 1811410236 | Lindsey Deborah Sanborn | Nurse Practitioner | 301 Prospect Avenue St. Josephs's Hospital Health Cente, Syracuse, NY 13203 | 2017-07-18 |
| 1497205975 | Phuong Pham | Counselor | 329 North Salina Street, Syracuse, NY 13203 | 2016-10-10 |
| 1932574217 | Kaleigh Marie Andino | Audiologist | 1001 James Street, Syracuse, NY 13203 | 2015-12-11 |
| 1376889493 | Brenda S Hartman-souder | Social Worker | 526 Oak St., Syracuse, NY 13203 | 2012-12-18 |
| 1386914711 | Steven W Dimarzo | Counselor | 404 Oak St Ste 320, Syracuse, NY 13203 | 2012-01-02 |
| 1699052084 | Jessica Kinne | Social Worker | 1045 James Street, Syracuse, NY 13203 | 2011-11-14 |
| Find all providers in zip 13203 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679198857 | Syed Fazal Shah | Nurse Practitioner | 719 Harrison St Rm 126, Syracuse, NY 13210-2305 | 2020-06-12 |
| 1023675881 | John Justin Ringhisen | Nurse Practitioner | 500 Harrison St Apt 803, Syracuse, NY 13202-3003 | 2019-05-28 |
| 1720535099 | I - View Psychiatric Np Behavioral Therapy PC | Nurse Practitioner | 5640 E Taft Rd, 5096, Syracuse, NY 13220-9810 | 2016-09-04 |
| 1255696811 | Tammy L Balamut | Nurse Practitioner | 404 Oak St Ste 263, Syracuse, NY 13203-2976 | 2012-07-10 |
| 1558648733 | Jacquelynn Schultz Duquette | Nurse Practitioner | Suny Upstate Child and Adolescent Psychiatry Clinic, 713 Harrison Street, Syracuse, NY 13210 | 2011-11-15 |
| 1265030753 | Mallory Conner | Nurse Practitioner | 736 Irving Ave, Syracuse, NY 13210-1687 | 2020-10-15 |
| 1396361473 | Sydney Meadows | Nurse Practitioner | 847 James St, Syracuse, NY 13203-2504 | 2020-06-24 |
| 1346866829 | Candace S. Carter | Nurse Practitioner | 719 Harrison St, Syracuse, NY 13210-2305 | 2020-06-22 |
| 1508482282 | Yichao Zhang | Nurse Practitioner | 750 E Adams St, Syracuse, NY 13210-2306 | 2020-06-18 |
| 1871142687 | Brian Dewayne Frank | Nurse Practitioner | 750 E Adams St, Syracuse, NY 13210-1834 | 2019-09-05 |
| Find all providers in SYRACUSE | ||||
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| 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.