Provider Demographics
NPI:1861814535
Name:ACOY, SHENELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:SHENELLE
Middle Name:
Last Name:ACOY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR
Mailing Address - Street 2:STE A102
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8419
Mailing Address - Country:US
Mailing Address - Phone:815-759-4323
Mailing Address - Fax:815-759-4948
Practice Address - Street 1:4309 W MEDICAL CENTER DR
Practice Address - Street 2:STE A102
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-8419
Practice Address - Country:US
Practice Address - Phone:815-759-4323
Practice Address - Fax:815-759-4948
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily