Healthcare Provider Details

I. General information

NPI: 1326569849
Provider Name (Legal Business Name): SHANNON ANNE COLEMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 10TH ST
NIAGARA FALLS NY
14301-1870
US

IV. Provider business mailing address

2320 LOCKPORT OLCOTT RD
NEWFANE NY
14108-9514
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-4000
  • Fax:
Mailing address:
  • Phone: 716-983-1347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number020920-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: