Shannon Derose RPA-C

NPI 1407004898 - Physician Assistant - 363A00000X

NPI Details
NPI 1407004898
Gender Female
Enumeration Date 08/28/2008
Last Updated 05/27/2016
Entity Type Individual
Active Over 8 years ago
Practice Location
1555 LONG POND RD
ROCHESTER NY, 14626-4122, US
Phone (585) 723-7281
Fax (585) 723-8660
Business Location
1555 LONG POND RD
ROCHESTER NY, 14626-4122, US
Phone (585) 723-7281
Fax (585) 723-8660
Toxanomy
Taxonomy Code 363A00000X
License State New York
License Number 012694-1
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According to our database, Shannon Derose RPA-C NPI is 1407004898, taxonomy code is 363A00000X and license number is 012694-1, license state is located at New York. Shannon Derose RPA-C physically located at 1555 Long Pond Rd, Rochester NY, 14626-4122. NPI Number Shannon Derose RPA-C has the Individual type.

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1407004898 NPI number is provided on an as is basis without warranty of any kind. 1407004898 is maintained by the National Plan & Provider Enumeration System. The contents of Shannon Derose RPA-C are for informational purposes only.