Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Shane Tyler Pettis

Individual provider Peer Specialist · NPI 1386214807

Shane Tyler Pettis is a Peer Specialist in Amherst, New York. Practices as a sole proprietor. Registered with an NPI since 2021.

In the registry since
2021

Practice location Address checks out

1412 Sweet Home Rd Ste 3-5
Amherst, NY 14228-2795
Phone: (716) 589-1411
Fax: (716) 276-3051
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Peer Specialist (primary) Taxonomy 175T00000X

Record details

NPI number1386214807
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 28, 2021
Last updated in NPPESJune 28, 2021
Certification dateJune 28, 2021
Mailing address1412 Sweet Home Rd Ste 3-5, Amherst, NY 14228-2795

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