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General NPI Number Information
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NPI Number | 1518902899
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Entity Type | Individual
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Provider Name | SHANNON M BUNCH RPA-C
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Gender | Female
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 500 STERLING DR
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1573
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Country | US
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Telephone | 716-677-2273
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Fax | 716-677-2477
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Provider Business Mailing Address
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Address Line | 500 STERLING DR
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City | ORCHARD PARK
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State | NY
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Zip | 14127-1573
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Country | US
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Telephone | 716-677-2273
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Fax | 716-677-2477
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 010939-1
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License Number State | NY
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