Provider Demographics
NPI:1003880113
Name:COTTON, SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:COTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 OLEAN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2540
Mailing Address - Country:US
Mailing Address - Phone:716-805-1072
Mailing Address - Fax:716-805-1073
Practice Address - Street 1:112 OLEAN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2540
Practice Address - Country:US
Practice Address - Phone:716-805-1072
Practice Address - Fax:716-805-1073
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY148126BFOtherPREFERRED CARE
NY191738OtherLICENSE
NY00010036703OtherUNIVERA
NY000511934006OtherBC/BS
NY01781593Medicaid
NY040426003843OtherFIDELIS
NY080192888OtherRAILROAD MEDICARE
NY0105594OtherIHA
NYCK7008OtherRAILROAD MEDICARE
NY01781593Medicaid
NYAA1440Medicare PIN
NY191738OtherLICENSE