Provider Demographics
NPI:1023733516
Name:SCHULTZ, SHANNON JAYE (RT, RDCS, RVT)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:JAYE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:RT, RDCS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 N BAILEY AVE UNIT 213
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14226-6908
Mailing Address - Country:US
Mailing Address - Phone:716-435-4650
Mailing Address - Fax:
Practice Address - Street 1:327 WESTFIELD RD N
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-2429
Practice Address - Country:US
Practice Address - Phone:716-868-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1740892085U0001X, 246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty