Individual
EDWARD SHANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(516) 998-5800
Mailing address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(585) 275-7424
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
308328
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
248830877
DRIVERS LICENSE
NY
Enumeration date
04/27/2018
Last updated
07/14/2021
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