Provider Demographics
NPI:1164252060
Name:SYLVER, SHANNON RENELLE (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENELLE
Last Name:SYLVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAMARONECK AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1614
Mailing Address - Country:US
Mailing Address - Phone:914-381-2996
Mailing Address - Fax:
Practice Address - Street 1:550 MAMARONECK AVE STE 410
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1614
Practice Address - Country:US
Practice Address - Phone:914-381-2996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311909-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health