Provider Demographics
NPI:1881946598
Name:SHUTTS, CARMEN MICHELLE
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MICHELLE
Last Name:SHUTTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BURROUGHS DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3968
Mailing Address - Country:US
Mailing Address - Phone:716-839-4185
Mailing Address - Fax:
Practice Address - Street 1:155 BURROUGHS DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3968
Practice Address - Country:US
Practice Address - Phone:716-839-4185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist