SHAUNA MARIE KETCHUM (NPI# 1750617072) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750617072 |
| Entity Type | Individual |
| Full Name | SHAUNA MARIE KETCHUM |
| Other Name | SHAUNA MARIE MCCORRY |
| Credential | RPA-C |
| Practice Address |
300 West Ave Brockport NY 14420-1118 |
| Practice Telephone | 5856373905 |
| Practice Fax Number | 5856374990 |
| Mailing Telephone | 5856373905 |
| Mailing Fax Number | 5856374990 |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2010-09-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
013457-1 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
300 WEST AVE |
| City | BROCKPORT |
| State | NY |
| Zip Code | 14420-1118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790749471 | Robert William Ford | Optometrist | 300 West Ave, Oak Orchard Community Health Center, Brockport, NY 14420 | 2006-04-12 |
| 1275003659 | Kimberly Sue Walitzer | Psychologist | 300 West Ave, Brockport, NY 14420-1118 | 2018-11-28 |
| 1720599533 | Erin Elisabeth Goodrich | Dietitian, Registered | 300 West Ave, Brockport, NY 14420-1118 | 2017-10-19 |
| 1790224335 | Valerie Mostyn | Social Worker | 300 West Ave, Brockport, NY 14420-1118 | 2017-02-15 |
| 1316485378 | Christina Smith | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2017-02-09 |
| 1447606215 | Chanh Huynh | Family Medicine | 300 West Ave, Brockport, NY 14420 | 2016-05-10 |
| 1851755664 | Tammy L Cornelius | Dental Hygienist | 300 West Ave, Brockport, NY 14420-1118 | 2016-04-07 |
| 1962890608 | Katherine Ann Trawick | Dentist | 300 West Ave, Brockport, NY 14420-1118 | 2015-01-05 |
| 1336537562 | Catherine Goetz | Physician Assistant | 300 West Ave, Brockport, NY 14420-1118 | 2014-12-22 |
| 1538592258 | Kelsey Eleanor Miller | Pediatrics | 300 West Ave, Brockport, NY 14420-1118 | 2013-08-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194217471 | Brianna Lynn Bunch | Licensed Practical Nurse | 126 White Road, Brockport, NY 14420 | 2018-06-03 |
| 1174012785 | Penny Bowers | Massage Therapist | 27 Market Street, Upstairs, Brockport, NY 14420 | 2018-05-09 |
| 1386172062 | Allison Manly | Dentist | 1000 Transit Way, Brockport, NY 14420 | 2017-05-25 |
| 1235518143 | Erin B Chapman | Physical Medicine & Rehabilitation | 350 New Campus Drive, Brockport, NY 14420 | 2015-05-26 |
| 1972853653 | Theresa Fox Lehman | Specialist | 32 Mission Hill Drive, Brockport, NY 14420 | 2012-09-11 |
| 1689946303 | Beverly Whiteman | Registered Nurse | 40 Allen St., Brockport, NY 14420 | 2012-01-27 |
| 1316217425 | Julie Ann Knapp | Registered Nurse | 40 Allen Street, Brockport Central School District, Brockport, NY 14420 | 2012-01-05 |
| 1851678965 | Jennifer Anne Cohen | Registered Nurse | 188 Utica Street, Brockport, NY 14420 | 2011-11-03 |
| 1205088960 | Amy Maureen Hennessy | Obstetrics & Gynecology | 6668 Fourth Section Rd Ste 500, Brockport, NY 14420 | 2008-10-14 |
| 1053454884 | Nancy S Iafrati | Nurse Practitioner | Suny Brockport Student Health Center, 350 New Campus Drive, Brockport, NY 14420 | 2007-02-14 |
| Find all providers in zip 14420 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093784704 | Kelly Jean Halvonik | Physician Assistant | Interlakes Oncology & Hematology PC, 156 West Ave., Brockport, NY 14420 | 2006-03-15 |
| 1992773840 | Brenda M Spencer | Physician Assistant | 6668 Fourth Section Rd, Brockport, NY 14420-2448 | 2006-03-08 |
| 1275045791 | Josiah James Surbatovich | Physician Assistant | 170 West Ave, Brockport, NY 14420-1227 | 2017-10-25 |
| 1043769326 | Emma L Leatham | Physician Assistant | 156 West Ave, Brockport, NY 14420-1229 | 2016-09-27 |
| 1104126549 | Lori Jeanne Mckee | Physician Assistant | 6668 Fourth Section Rd, Brockport, NY 14420-2448 | 2010-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487252581 | North Shore Medical Group Pllc | Physician Assistant | 311 Skyview Ter, Syracuse, NY 13219-2835 | 2020-10-12 |
| 1477169654 | Kristen Ariel O'connell | Physician Assistant | 85 John St Apt 7a, New York, NY 10038-2844 | 2020-09-22 |
| 1699381616 | David Nmn Kao | Physician Assistant | 737 Pleasant Avenue, Westbury, NY 11590-6407 | 2020-09-16 |
| 1043824816 | Elizabeth Keane | Physician Assistant | 25 Hollis Dr, Sound Beach, NY 11789-1629 | 2020-08-31 |
| 1497364111 | Tianna Stephens | Physician Assistant | 165 N Village Ave Ste 5, Rockville Centre, NY 11570-3701 | 2020-07-28 |
| 1124636188 | Shannon Maureen O'connell | Physician Assistant | 270-05 270th Ave, New Hyde Park, NY 11040 | 2020-07-16 |
| 1841818895 | Yanick Dugue | Physician Assistant | 4 Lincoln Ave, New Hyde Park, NY 11040-3125 | 2020-07-07 |
| 1194340505 | Kayleigh Marie Tourt | Physician Assistant | 222 Alexander St Fl 4, Rochester, NY 14607-4039 | 2020-06-11 |
| 1023638509 | Kristina Rajic | Physician Assistant | 7237 66th Dr, Flushing, NY 11379-2111 | 2020-04-24 |
| 1114547791 | Michele Hein | Physician Assistant | 700 Veterans Memorial Hwy, Hauppauge, NY 11788-2952 | 2020-04-23 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SHAUNA MARIE KETCHUM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.