SHANNON DEROSE (NPI# 1407004898) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407004898 |
| Entity Type | Individual |
| Full Name | SHANNON DEROSE |
| Other Name | SHANNON PARKER |
| Credential | RPA-C |
| Practice Address |
125 Red Creek Dr Ste 205 Rochester NY 14623-4262 |
| Mailing Address |
1555 Long Pond Rd Rochester NY 14626-4122 |
| Practice Telephone | 5857237600 |
| Practice Fax Number | 5853346373 |
| Mailing Telephone | 5857237281 |
| Mailing Fax Number | 5857238660 |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
012694 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03607632 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2115 Chili Ave, Rochester, NY 146243425 | 5857237600 | 5852470075 |
| Street Address |
125 RED CREEK DR STE 205 |
| City | ROCHESTER |
| State | NY |
| Zip Code | 14623-4262 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962470443 | John W. Gibbs | Orthopaedic Surgery | 125 Red Creek Dr Ste 205, Rochester, NY 14623-4262 | 2006-03-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235637141 | Cornerstone Dental of Henrietta | Dentist | 2104 E. Henrietta Road, Rochester, NY 14623 | 2018-01-25 |
| 1770019713 | Brenna Cavanaugh | Psychologist | 200 East River Rd., Rochester, NY 14623 | 2017-05-11 |
| 1932649522 | Annette F. Cranker | Registered Nurse | 100 Groton Parkway, Rochester, NY 14623 | 2017-03-01 |
| 1588049258 | Lisa Parnell | Nurse Practitioner | 200 East River Road, Rochester, NY 14623 | 2015-07-23 |
| 1811371610 | Deanna Phoenix | Pharmacist | Elm & Carlton Streets, Main Hospital, Roswell Park Cancer Institute, Buffalo, NY 14623 | 2015-07-13 |
| 1518340801 | Erin Wong | Counselor | 945 E. Henrietta Rd, Suite 7a, Rochester, NY 14623 | 2015-07-04 |
| 1427437490 | Sarah Beren | Counselor | 115 Metro Park, Rochester, NY 14623 | 2015-05-23 |
| 1346628930 | Bohdan Klymochko | Family Medicine | 1300 Jefferson Rd Ste 100, Rochester, NY 14623 | 2015-05-14 |
| 1306242763 | Rochester Institute of Technology | Psychiatric Unit | 1 Lomb Memorial Drive, Rochester, NY 14623 | 2014-11-13 |
| 1972904423 | Jonathan Bloom | Urology | 400 White Spruce Blvd Ste B, Rochester, NY 14623 | 2014-09-15 |
| Find all providers in zip 14623 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518411107 | Michelle Ann Swider | Physician Assistant | 1425 Portland Ave Ste 220, Rochester, NY 14621-3011 | 2016-08-11 |
| 1124423355 | Amanda Schnorf | Physician Assistant | 2824 W Ridge Rd, Rochester, NY 14626-1639 | 2014-10-30 |
| 1679989479 | Jacob William Raifstanger | Physician Assistant | 2655 Ridgeway Ave Ste 460, Rochester, NY 14626-4296 | 2014-07-01 |
| 1225385305 | Katie Elizabeth Kenny | Physician Assistant | 1555 Long Pond Rd Fl 1, Rochester, NY 14626-4122 | 2012-08-08 |
| 1558683904 | Oswaldo Serge | Physician Assistant | 4036 3rd St Nw, Rochester, MN 55901-7564 | 2010-02-25 |
| 1417288945 | Amanda Kay Johnson | Physician Assistant | 201 W Center St Ei-01 Surgical Assistant, Rochester, MN 55902-3003 | 2010-01-22 |
| 1033322797 | Joan Marie Wobig | Physician Assistant | 5426 15th St Se, Rochester, MN 55904-6719 | 2007-05-08 |
| 1871705749 | Beverley Myers | Physician Assistant | 4730 17th St Se, Rochester, MN 55904-6680 | 2007-05-04 |
| 1831310739 | Brenda Gerdts | Physician Assistant | 4838 Scenic View Dr Sw, Rochester, MN 55902-1527 | 2007-05-01 |
| 1558419739 | Kathryn Ann Ciurca | Physician Assistant | 868 Clover St, Rochester, NY 14610-3232 | 2007-01-06 |
| Find all providers in ROCHESTER | ||||
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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.