Provider Demographics
NPI:1023597200
Name:IRISH, SHANNON RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:IRISH
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3925 SHERIDAN DR
Mailing Address - Street 2:STE 100
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-6492
Mailing Address - Fax:716-250-6522
Practice Address - Street 1:36 N UNION RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5383
Practice Address - Country:US
Practice Address - Phone:716-636-1470
Practice Address - Fax:716-636-1423
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2019-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY022057363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical