Shane Tyler Pettis

NPI #1386214807 in Amherst, New York

Provider Information

NPI Number: 1386214807
Entity Type: Individual
Name: Shane Tyler Pettis
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Enumeration Date: Jun 28, 2021
Last Updated: Jun 28, 2021

Practice Location

Address: 1412 SWEET HOME RD STE 3-5
City: Amherst
State: New York
ZIP Code: 14228-2795
Phone: (716) 589-1411

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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