Individual
DR. JACQUELINE SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
3670 S BENZING RD, ORCHARD PARK, NY 14127
(716) 662-5357
Mailing address
425 ESSJAY RD STE 170, WILLIAMSVILLE, NY 14221-5782
(716) 630-1219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
280972
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/14/2008
Last updated
12/13/2021
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