National Provider Identifier
Shane Tyler Pettis
Shane Tyler Pettis is listed in the NPPES registry with a primary specialty of Peer Specialist in Amherst, NY and a listed phone number of (716) 589-1411.
Profile Overview
- NPI
- 1386214807
- Provider Type
- Individual
- Primary Specialty
- Peer Specialist
- Enumeration Date
- June 28, 2021
- Last Updated
- June 28, 2021
Practice Location
- 1412 Sweet Home RD Ste 3-5
- Amherst, NY 14228-2795
Phone: (716) 589-1411
Specialties
- Peer Specialist (175T00000X)
Full Record
- NPI
- 1386214807
- Entity Type
- Individual
- Last Name
- Pettis
- First Name
- Shane
- Middle Name
- Tyler
- Mailing Street Address
- 1412 Sweet Home RD Ste 3-5
- Mailing City
- Amherst
- Mailing State
- NY
- Mailing ZIP Code
- 14228-2795
- Mailing Country
- US
- Mailing Phone
- (716) 589-1411
- Mailing Fax
- (716) 276-3051
- Practice Street Address
- 1412 Sweet Home RD Ste 3-5
- Practice City
- Amherst
- Practice State
- NY
- Practice ZIP Code
- 14228-2795
- Practice Country
- US
- Practice Phone
- (716) 589-1411
- Practice Fax
- (716) 276-3051
- Enumeration Date
- June 28, 2021
- Last Updated
- June 28, 2021
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- June 28, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Peer Specialist (175T00000X)