Provider Demographics
NPI:1568533917
Name:SHANAHAN, THOMAS C (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:SHANAHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MIDDLEBURY RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3581
Mailing Address - Country:US
Mailing Address - Phone:716-667-1507
Mailing Address - Fax:
Practice Address - Street 1:110 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1630
Practice Address - Country:US
Practice Address - Phone:716-566-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSHANT1170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics