Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shannon Derose, RPA-C

Individual provider Surgical Physician Assistant · NPI 1407004898

Shannon Derose, RPA-C is a Physician Assistant in Rochester, New York. Qualified in 2008, 18 years ago. Practices with Western New York Medical Practice PC, a 528-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in New York.

Years since qualifying
18
Licensed in
NY
In the registry since
2008
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Practice location Address checks out

125 Red Creek Dr Ste 205
Rochester, NY 14623-4262
Phone: (585) 723-7600
Fax: (585) 334-6373
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2115 Chili Ave, Rochester, NY 14624-3425 — (585) 723-7600

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 012694 (NY)

Record details

NPI number1407004898
Entity typeIndividual (Type 1)
GenderFemale
Credentials RPA-C
Sole proprietorNo
NPI enumeratedAugust 28, 2008
Last updated in NPPESSeptember 14, 2022
Certification dateSeptember 14, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2008 (18 years in practice)
Group practice Western New York Medical Practice Pc — 528 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Rochester