Provider Demographics
NPI:1013922855
Name:RAST, SHIRLEY A (NP)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:RAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 670
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-276-3616
Mailing Address - Fax:585-473-1691
Practice Address - Street 1:2180 SOUTH CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-276-3616
Practice Address - Fax:585-473-1691
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403112163W00000X
NYF333350363LF0000X
NY333350363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02809378Medicaid
NYQ49357Medicare UPIN
NYRA7620Medicare ID - Type UnspecifiedMEDICARE
NY02809378Medicaid