| Doctor Name: | SHANNON NICOLE PELLETIER |
| NPI Number: | 1164653622 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 335917 |
| Business Practice Address: | 358 Madison St Waterville, NY - 134801116 |
| Business Phone Number: | 3158414973 |
| Business Fax Number: | |
| Mailing Address: | 611 N Jay St, ROME |
| State: | NY |
| Postal Code: | 134403306 |
| Phone Number: | 3153341019 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2009 |
| NPI Last Update Date: | 05/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 335917 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |