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General NPI Number Information
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NPI Number | 1750798625
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Entity Type | Individual
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Provider Name | SHANNON MARIE O'BRIEN ANP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2014
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Last Update Date | 07/12/2014
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Provider Practice Location Address
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Address Line | 515 ABBOTT RD
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City | BUFFALO
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State | NY
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Zip | 14220-1700
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Country | US
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Telephone | 716-828-2478
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Fax |
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Provider Business Mailing Address
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Address Line | 31 WEDGEWOOD DR
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City | WEST SENECA
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State | NY
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Zip | 14224-3623
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Country | US
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Telephone | 716-997-2590
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F306915-1
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License Number State | NY
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