Healthcare Provider Details

I. General information

NPI: 1639410319
Provider Name (Legal Business Name): CHRISTOPHER M SHANAHAN RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2013
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 ABBOTT RD
ORCHARD PARK NY
14127-2229
US

IV. Provider business mailing address

4225 GENESEE ST STE 400
CHEEKTOWAGA NY
14225-1994
US

V. Phone/Fax

Practice location:
  • Phone: 716-204-3200
  • Fax: 716-204-4337
Mailing address:
  • Phone: 716-204-3200
  • Fax: 716-204-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: