Provider Demographics
NPI:1265668776
Name:SHUTTY, CHRISTOPHER MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:SHUTTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1125 BANNER AVE
Mailing Address - Street 2:APT. 10C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5260
Mailing Address - Country:US
Mailing Address - Phone:718-853-6433
Mailing Address - Fax:718-853-6449
Practice Address - Street 1:904 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2922
Practice Address - Country:US
Practice Address - Phone:718-853-6433
Practice Address - Fax:718-853-6449
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA229422207ZP0102X
NY257416207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology