MEDICARE: KATHLEEN SHANNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R025366	NY

General Provider Information

NPI Number	:	1023084027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN SHANNON

Provider Business Mailing Address
First Line	:	3980 SHERIDAN DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-1727
Country	:	US
Telephone Number	:	716-961-9900
Fax Number	:	716-961-9911

Provider Business Practice Location Address
First Line	:	3980 SHERIDAN DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14226-1727
Country	:	US
Telephone Number	:	716-961-9900
Fax Number	:	716-961-9911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	06/02/2014

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Directions to “ KATHLEEN SHANNON ” Practice Location

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