MEDICARE: MRS. SHAUNY LYNN CARUSO ATC

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	2255A2300X	Athletic Trainer	001340	NY

General Provider Information

NPI Number	:	1447328778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAUNY LYNN CARUSO ATC

Provider Business Mailing Address
First Line	:	112 POND VIEW HTS
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14612-1308
Country	:	US
Telephone Number	:	586-703-4498
Fax Number	:

Provider Business Practice Location Address
First Line	:	GOERGEN ATHLETIC CENTER
Second Line	:	UNIVERSITY OF ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14627
Country	:	US
Telephone Number	:	585-275-4890
Fax Number	:	585-461-5081

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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