Provider Demographics
NPI:1487994398
Name:MEYERS, SHANNON (CRNA)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MEYERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-1039
Mailing Address - Country:US
Mailing Address - Phone:716-783-9991
Mailing Address - Fax:
Practice Address - Street 1:4185 SENECA ST STE 11
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3565
Practice Address - Country:US
Practice Address - Phone:716-674-8189
Practice Address - Fax:716-712-0469
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY537487363AM0700X
NY537487-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical