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

Shauna Marie Ketchum, RPA-C

Individual provider Medical Physician Assistant · NPI 1750617072

Shauna Marie Ketchum, RPA-C is a Physician Assistant in Brockport, New York. Qualified in 2009, 17 years ago. Practices with University of Rochester, a 962-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
17
Licensed in
NY
In the registry since
2009

Practice location Address checks out

300 W Ave
Brockport, NY 14420-1118
Phone: (585) 637-3905
Fax: (585) 637-4990
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 013457-1 (NY)

Record details

NPI number1750617072
Entity typeIndividual (Type 1)
GenderFemale
Credentials RPA-C
Sole proprietorNo
NPI enumeratedOctober 21, 2009
Last updated in NPPESJune 14, 2024
Certification dateJune 14, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice University Of Rochester — 962 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Brockport