Provider Demographics
NPI:1710599592
Name:CIERI, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:CIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3632
Mailing Address - Country:US
Mailing Address - Phone:585-241-9000
Mailing Address - Fax:
Practice Address - Street 1:259 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3632
Practice Address - Country:US
Practice Address - Phone:585-241-9000
Practice Address - Fax:585-454-2017
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist