National Provider Identifier
Shauna Marie Ketchum, RPA-C
Shauna Marie Ketchum, RPA-C is listed in the NPPES registry with a primary specialty of Medical Physician Assistant in Brockport, NY and a listed phone number of (585) 637-3905.
Profile Overview
- NPI
- 1750617072
- Provider Type
- Individual
- Primary Specialty
- Medical Physician Assistant
- Enumeration Date
- October 21, 2009
- Last Updated
- June 14, 2024
Practice Location
- 300 West Ave
- Brockport, NY 14420-1118
Phone: (585) 637-3905
Specialties
- Medical Physician Assistant (363AM0700X)
Full Record
- NPI
- 1750617072
- Entity Type
- Individual
- Last Name
- Ketchum
- First Name
- Shauna
- Middle Name
- Marie
- Credential
- RPA-C
- Provider Other Last Name
- McCorry
- Provider Other First Name
- Shauna
- Provider Other Middle Name
- Marie
- Provider Other Credential Text
- RPA-C
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 300 West Ave
- Mailing City
- Brockport
- Mailing State
- NY
- Mailing ZIP Code
- 14420-1118
- Mailing Country
- US
- Mailing Phone
- (585) 637-3905
- Mailing Fax
- (585) 637-4990
- Practice Street Address
- 300 West Ave
- Practice City
- Brockport
- Practice State
- NY
- Practice ZIP Code
- 14420-1118
- Practice Country
- US
- Practice Phone
- (585) 637-3905
- Practice Fax
- (585) 637-4990
- Enumeration Date
- October 21, 2009
- Last Updated
- June 14, 2024
- Sex
- Female
- Sole Proprietor
- No
- Certification Date
- June 14, 2024
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Medical Physician Assistant (363AM0700X)