Shelly Lynn Peters, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

402033 Issued in NY

Practice address

324 University Ave FL 3
Syracuse, NY 13210-1811

Phone

(315) 362-2540

Fax

(315) 361-1786

NPI assigned

Aug 6, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Shelly Lynn Pangburn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: speters@hiemail.healtheconnections.org
• Direct secure messaging: shelly_lynn_peters_pmhnp@hiemail.healtheconnections.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teapot Ministry Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Syracuse, NY
  • NPI 1356207575
  NPD Authorized official
• St Joseph'S Hospital Health Center

  • Internal Medicine Physician
  • Syracuse, NY
  • NPI 1699832436
  NPD
• St Josephs Hospital Health Center

  • General Acute Care Hospital
  • Syracuse, NY
  • NPI 1508815333
  NPD
• St Josephs Medical PC

  • Family Medicine Physician
  • Liverpool, NY
  • NPI 1942501747
  NPD
• St. Joseph'S Physician Health, P.C.

  • Anesthesiology Physician
  • Troy, NY
  • NPI 1154376770
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1942754015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 UNIVERSITY AVE FL 3",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101811",
            "telephone_number": "315-362-2540",
            "fax_number": "315-671-1786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 UNIVERSITY AVE FL 3",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101811",
            "telephone_number": "315-362-2540",
            "fax_number": "315-361-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "SHELLY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-08-06",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "402033",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "402033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04532216",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHELLY",
            "last_name": "PANGBURN",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Pesci
• Michael P Pesci, PA
• Christopher Peters, MLS
• Kacey Pauline Peters, LMSW
• Marsha Peters
• Peterson & Nellis Physical Therapy PC
• Brittany Peterson, LPN
• Christopher Lee Peterson
• Craig Peterson
• Iva Kay Peterson, RN

• Psychiatric/Mental Health Nurse Practitioner in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.