Provider Demographics
NPI:1912294471
Name:GRIFFIN, SHANE PATRICK (PA)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:PATRICK
Last Name:GRIFFIN
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5500 MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6766
Mailing Address - Country:US
Mailing Address - Phone:716-898-4427
Mailing Address - Fax:716-898-3678
Practice Address - Street 1:5500 MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6766
Practice Address - Country:US
Practice Address - Phone:716-898-5506
Practice Address - Fax:716-898-3678
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2014-05-12
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Provider Licenses
StateLicense IDTaxonomies
NY014832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant