Provider Demographics
NPI:1528005709
Name:KANE, SHELLY M (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:M
Last Name:KANE
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 1:1850 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2448
Mailing Address - Country:US
Mailing Address - Phone:585-342-3870
Mailing Address - Fax:585-342-7938
Practice Address - Street 1:1850 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2448
Practice Address - Country:US
Practice Address - Phone:585-342-3870
Practice Address - Fax:585-342-7938
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC1507Medicare ID - Type Unspecified
NYG51971Medicare UPIN