MEDICARE: SHAUNA COLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA-980	NV
2	363AM0700X	Medical Physician Assistant	021964-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336186550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNA COLE PA-C

Provider Business Mailing Address
First Line	:	120 ERIE CANAL DR STE 200
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4609
Country	:	US
Telephone Number	:	585-719-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 ERIE CANAL DR STE 200
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4609
Country	:	US
Telephone Number	:	585-719-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/29/2023

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Directions to “ SHAUNA COLE PA-C” Practice Location

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