Provider Demographics
NPI:1326044686
Name:WOOLF, SHANE K (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:K
Last Name:WOOLF
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 1:7785 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1229
Mailing Address - Country:US
Mailing Address - Phone:315-376-5200
Mailing Address - Fax:
Practice Address - Street 1:7785 N STATE ST STE 120
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1297
Practice Address - Country:US
Practice Address - Phone:315-376-4505
Practice Address - Fax:315-376-4259
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2005-0142207X00000X
SC21387207X00000X, 207XX0005X
NY319067207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine