Healthcare Provider Details

I. General information

NPI: 1437126190
Provider Name (Legal Business Name): LAURIE CAROLINE SHIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ENGLISH RD
ROCHESTER NY
14616-1691
US

IV. Provider business mailing address

4 STONEBRIDGE LANE
PITTSFORD NY
14534
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2525
  • Fax: 585-225-2626
Mailing address:
  • Phone: 585-225-2525
  • Fax: 585-225-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2197981
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: