Basic Information
| Provider Information | |||||||||
| NPI: | 1295981678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHANNON | ||||||||
| FirstName: | JOANNE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 677 MCKINLEY PKWY | ||||||||
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| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142201521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168649238 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 CENTRE DR | ||||||||
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| City: | ORCHARD PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141274100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166672294 | ||||||||
| FaxNumber: | 7166672272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2008 | ||||||||
| LastUpdateDate: | 03/16/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 006230 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.