Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | SHANT1 | NY |
NPI | 1568533917 |
---|---|
Provider Name | Dr. Thomas C Shanahan |
First Address | Orchard Park, NY 14127-3581 |
Second Address | Buffalo, NY 14203-1630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/07/2007 |