Healthcare Provider Details

I. General information

NPI: 1689466211
Provider Name (Legal Business Name): SHANNON ROBINSON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 KENSINGTON AVE
BUFFALO NY
14226-4927
US

IV. Provider business mailing address

2041 SW BEEKMAN ST
PORT SAINT LUCIE FL
34953-1766
US

V. Phone/Fax

Practice location:
  • Phone: 716-437-6453
  • Fax:
Mailing address:
  • Phone: 772-985-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: