Provider Demographics
NPI:1497838502
Name:SHAHEEN, BEVERLY (MSNP)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:MSNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 RIDGE RD W
Mailing Address - Street 2:BUILDING D
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3249
Mailing Address - Country:US
Mailing Address - Phone:585-225-1580
Mailing Address - Fax:585-225-3137
Practice Address - Street 1:3101 RIDGE RD W
Practice Address - Street 2:BUILDING D
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-3249
Practice Address - Country:US
Practice Address - Phone:585-225-1580
Practice Address - Fax:585-225-3137
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420136-1363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP019360036OtherEXCELLUS MANAGED CARE
NYP019360036OtherEXCELLUS MANAGED CARE