Provider Demographics
NPI:1821027384
Name:PITTS, SHANNON D (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:D
Last Name:PITTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2400 S CLINTON AVE
Practice Address - Street 2:BLDG H SUITE 110
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-341-7141
Practice Address - Fax:585-461-4426
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00728104OtherMEDICARE RAILROAD
NYP00728104OtherMEDICARE RAILROAD
NYI45564Medicare UPIN