Individual
SHANNON DEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPA-C
Contact information
Practice address
125 RED CREEK DR STE 205, ROCHESTER, NY 14623-4262
(585) 723-7600
(585) 334-6373
Mailing address
1555 LONG POND RD, ROCHESTER, NY 14626-4122
(585) 723-7281
(585) 723-8660
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
012694
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03607632
—
NY
Enumeration date
08/28/2008
Last updated
09/14/2022
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