Provider Demographics
NPI:1518902899
Name:BUNCH, SHANNON M (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:M
Last Name:BUNCH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1573
Mailing Address - Country:US
Mailing Address - Phone:716-677-2273
Mailing Address - Fax:716-677-2477
Practice Address - Street 1:500 STERLING DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1573
Practice Address - Country:US
Practice Address - Phone:716-677-2273
Practice Address - Fax:716-677-2477
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010939-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161511795OtherHUMANA
NY02740518Medicaid
NY189972FZOtherPREFERRED CARE
NY00027341602OtherUNIVERA
NY161511795OtherNOVA
NYP019010939OtherEXCELLUS BLUE CHOICE
NY9513046OtherINDEPENDENT HEALTH
NY060407000031OtherFIDELIS CARE
NYP00341649OtherRAILROAD MEDICARE
NY000570565002OtherCOMMUNITY BLUE
NY161511795OtherNORTH AMERICAN
NY4149287OtherMVP
NYP00341649OtherRAILROAD MEDICARE
NYQ59502Medicare UPIN