{
"Npi": {
"NPI": "1184092157",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FEIND",
"FirstName": "SHANNON",
"MiddleName": "KATHLEEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PT, DPT",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KELLY",
"OtherFirstName": "SHANNON",
"OtherMiddleName": "KATHLEEN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PT, DPT",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1789 EGGERT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AMHERST",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14226-2352",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "7 COMMUNITY DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CHEEKTOWAGA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14225-2523",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-505-5651",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/08/2015",
"LastUpdateDate": "09/06/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2251P0200X",
"TaxonomyName": "Pediatric Physical Therapist",
"LicenseNumber": "039573-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "039573",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}