Shane Tyler Pettis
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 3-5Amherst, NY 14228-2795
Phone: (716) 589-1411
Fax: (716) 276-3051
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Specialties & licences
| Peer Specialist (primary) | Taxonomy 175T00000X |
|---|
Record details
| NPI number | 1386214807 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | June 28, 2021 |
| Last updated in NPPES | June 28, 2021 |
| Certification date | June 28, 2021 |
| Mailing address | 1412 Sweet Home Rd Ste 3-5, Amherst, NY 14228-2795 |
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Gabrielle Cooper
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Cheryl Geartz
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