Provider Demographics
NPI:1861089039
Name:DOLE, SHENANDOAH PUTNEY (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:SHENANDOAH
Middle Name:PUTNEY
Last Name:DOLE
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 SILVER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14550-9702
Mailing Address - Country:US
Mailing Address - Phone:585-519-2859
Mailing Address - Fax:
Practice Address - Street 1:81 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1571
Practice Address - Country:US
Practice Address - Phone:585-228-1195
Practice Address - Fax:585-185-2067
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF310068363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health