Provider Demographics
NPI:1851700389
Name:SHELTERS, KENDRA LINDSEY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:LINDSEY
Last Name:SHELTERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 LONG POND RD
Mailing Address - Street 2:EMERGENCY CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7000
Mailing Address - Fax:585-723-7899
Practice Address - Street 1:1555 LONG POND RD
Practice Address - Street 2:EMERGENCY CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7000
Practice Address - Fax:585-723-7899
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AS0400X
NY017966363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03990681Medicaid
NYJ400235003/GRPBA0017Medicare PIN
NYJ400235002/GRP70008AMedicare PIN