Healthcare Provider Details

I. General information

NPI: 1497315568
Provider Name (Legal Business Name): SHANNON H MCCARTHY DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5853 TRANSIT RD
EAST AMHERST NY
14051-1885
US

IV. Provider business mailing address

5853 TRANSIT RD
EAST AMHERST NY
14051-1885
US

V. Phone/Fax

Practice location:
  • Phone: 716-689-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONDRA HEDDEN EDWARDS
Title or Position: CONSULTANT
Credential:
Phone: 404-695-6979