Individual
SHANNON KELLY QUACKENBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1001 MAIN ST STE K-3502, BUFFALO, NY 14203-1009
(716) 323-6658
Mailing address
1001 MAIN ST # K3502, BUFFALO, NY 14203-1009
(716) 323-6570
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN178240
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
748921-1
NY
367500000X
Certified Registered Nurse Anesthetist
RN629994
PA
Other
Enumeration date
04/23/2020
Last updated
08/01/2025
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