Individual
DR. SHANE CORBIN ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5300 MILITARY RD, LEWISTON, NY 14092-1903
(530) 012-7015
Mailing address
5300 MILITARY RD, LEWISTON, NY 14092-1903
(314) 514-3500
(716) 297-1701
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
336964
NY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
336964
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200144492
—
MO
Enumeration date
04/01/2019
Last updated
07/17/2025
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