Individual
IAN SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 ELMWOOD AVE FL 3, ROCHESTER, NY 14642-0001
(585) 275-2901
Mailing address
601 ELMWOOD AVE, ROCHESTER, NY 14642-0001
(585) 275-2100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
795387
NY
363L00000X
Nurse Practitioner
Primary
312441
NY
Other
Enumeration date
06/26/2025
Last updated
08/22/2025
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