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General NPI Number Information
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NPI Number | 1114001443
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Entity Type | Individual
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Provider Name | BRIAN ROBERT SHULL RPA-C
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10 HAGEN DR STE 350
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City | ROCHESTER
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State | NY
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Zip | 14625-2660
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Country | US
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Telephone | 585-385-5555
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Fax | 585-385-5611
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Provider Business Mailing Address
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Address Line | 33 FURMAN CRES
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City | ROCHESTER
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State | NY
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Zip | 14620-2801
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Country | US
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Telephone | 518-524-4314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 007747
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License Number State | NY
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