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General NPI Number Information
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NPI Number | 1942578174
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Entity Type | Individual
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Provider Name | KATHLEEN M SHANAHAN PHD
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Gender | Female
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Dates
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Enumeration Date | 12/02/2011
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Last Update Date | 07/30/2021
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Provider Practice Location Address
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Address Line | ELM AND CARLTON STREETS
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City | BUFFALO
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State | NY
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Zip | 14263
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Country | US
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Telephone | 716-845-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 18 AGASSIZ CIR
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City | BUFFALO
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State | NY
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Zip | 14214-2601
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Country | US
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Telephone | 716-932-2629
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Fax | 716-884-0291
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 015460
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License Number State | NY
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