SHELLEY MAE BACON (NPI# 1669966065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669966065 |
| Entity Type | Individual |
| Full Name | SHELLEY MAE BACON |
| Credential | NP |
| Practice Address |
4979 Harlem Rd Amherst NY 14226-2547 |
| Practice Telephone | 7169234380 |
| Practice Fax Number | 7169234384 |
| Mailing Telephone | 7169234380 |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2018-06-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
342993 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4979 HARLEM RD |
| City | AMHERST |
| State | NY |
| Zip Code | 14226-2547 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942297122 | John Bauers | Internal Medicine | 4979 Harlem Rd, Suite 1, Amherst, NY 14226-2547 | 2005-10-03 |
| 1174124333 | Shellee Anne Lusung Quaglia | Nurse Practitioner | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2020-11-04 |
| 1851902290 | Elena Kalabushkina | Nurse Practitioner | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2020-08-10 |
| 1336770718 | Maxwell Boasiako Antwi | Nurse Practitioner | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2020-02-04 |
| 1780246777 | Wny Medical PC - Care Management | Registered Nurse | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2019-07-01 |
| 1063970747 | Nancy Kawecki | Nurse Practitioner | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2019-03-12 |
| 1689150690 | Chanda Sadiq | Physician Assistant | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2018-07-12 |
| 1740708460 | Jill M Ector | Nurse Practitioner | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2017-09-01 |
| 1639528458 | Melitta Mendonca | Physician Assistant | 4979 Harlem Rd, Amherst, NY 14226-2547 | 2016-06-13 |
| 1225482151 | Kearsten Howe Ball | Physician Assistant | 4979 Harlem Rd, Suite 1, Amherst, NY 14226-2547 | 2016-04-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578175089 | Rafael Khavis | Dentist | Dent Tower Suite 401, 3980 Sheridan Drive, Amherst, NY 14226 | 2020-08-18 |
| 1942846209 | Anthony Constance | Occupational Therapist | Excelsior Orthopaedics, 3925 Sheridan Drive, Amherst, NY 14226 | 2019-11-21 |
| 1730743931 | Mark Marcello | Physical Therapy Assistant | 4498 Main/harlem Rd Suite 24, Amherst, NY 14226 | 2019-04-24 |
| 1528531084 | Kimberly Girdlestone | Social Worker | 3960 Harlem Road, Suite 6b, Buffalo, NY 14226 | 2019-01-08 |
| 1043781503 | Justin Patrick Nelson | Physical Therapist | 4498 Main St. Suite 24, Amherst, NY 14226 | 2018-12-10 |
| 1962979195 | Meghan Jim Dougher | Student in an Organized Health Care Education/Training Program | 167 Darwin Dr., Snyder, NY 14226 | 2018-10-25 |
| 1790260982 | Orchard Park Dentalcare Pllc | Clinic/Center | 3302 Sheridan Dr, Buffalo, NY 14226 | 2018-10-03 |
| 1619472719 | Rapha Family Medical Wellness PC | Family Medicine | 3610 Main Street, Amherst, NY 14226 | 2018-03-29 |
| 1790299832 | Medical Ecp of Western New York P C | Internal Medicine | 4330 Maple Rd Ste 102, Amherst, NY 14226 | 2017-11-28 |
| 1841709425 | Elisabeth Wagner | Physical Therapy Assistant | 4498 Main St., Suite 24, Amherst, NY 14226 | 2017-09-26 |
| Find all providers in zip 14226 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750929436 | Crystal Ann Hess | Nurse Practitioner | 46355 Middle Ridge Rd, Amherst, OH 44001-3201 | 2019-12-13 |
| 1205346558 | Kimberly Fuller Parr | Nurse Practitioner | 121 Ridge Dr, Amherst, VA 24521-3105 | 2017-10-01 |
| 1346763927 | Kerry A Anderson | Nurse Practitioner | 282 Route 101 # Units910, Amherst, NH 03031-1706 | 2017-07-25 |
| 1275996266 | Sharon Johnson Daughtry | Nurse Practitioner | 115 Ambriar Plz, Amherst, VA 24521-4741 | 2016-03-29 |
| 1760841068 | Brianna Theresa Trottier | Nurse Practitioner | 4510 Main St Ste 200, Amherst, NY 14226-3800 | 2016-02-15 |
| 1750708525 | Caroline Toussaint | Nurse Practitioner | 8 Limbo Ln, Amherst, NH 03031-1870 | 2014-03-18 |
| 1154750743 | Allyson Legacy | Nurse Practitioner | 282 State Route 101 # U910, Amherst, NH 03031-1706 | 2013-11-05 |
| 1811335425 | Mai Pha | Nurse Practitioner | 264 N Pleasant St, Amherst, MA 01002-1725 | 2013-06-06 |
| 1669727194 | Jessica Launh | Nurse Practitioner | 199 Route 101 Unit 6, Amherst, NH 03031-1735 | 2012-07-20 |
| 1134497498 | Chia-hui Chen | Nurse Practitioner | 360 Callodine Ave, Amherst, NY 14226-2971 | 2011-12-01 |
| Find all providers in AMHERST | ||||
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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.