MEDICARE: DR. CHRISTOPHER MICHAEL SHUTTY D.O.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	229422	MA
2	207ZC0500X	Cytopathology Physician	257416	NY
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	257416	NY

General Provider Information

NPI Number	:	1265668776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER MICHAEL SHUTTY D.O.

Provider Business Mailing Address
First Line	:	1125 BANNER AVE
Second Line	:	APT. 10C
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5260
Country	:	US
Telephone Number	:	718-853-6433
Fax Number	:	718-853-6449

Provider Business Practice Location Address
First Line	:	904 49TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2922
Country	:	US
Telephone Number	:	718-853-6433
Fax Number	:	718-853-6449

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

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	10/02/2014

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