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Shane Tyler Pettis
Peer Specialist in Amherst, New York
NPI 1386214807

Shane Tyler Pettis is a Peer Specialist based in Amherst, NY. Shane Tyler Pettis practices in Amherst, NY. The NPI Number for Shane Tyler Pettis is 1386214807 and holds a License No. (New York).

The current practice location address for Shane Tyler Pettis is 1412 Sweet Home Rd Ste 3-5, Amherst, NY and can be reached out via phone at 716-589-1411 and via fax at 716-276-3051. You can also correspond with Shane Tyler Pettis through the mailing address at 1412 SWEET HOME RD STE 3-5, AMHERST, NY - 14228-2795 (mailing address contact number: 716-589-1411).

Location: 1412 Sweet Home Rd Ste 3-5, Amherst, NY, 14228-2795
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1386214807
Provider Name
Shane Tyler Pettis
Credential
Provider Entity Type
Individual
Gender
Male
Address
1412 Sweet Home Rd Ste 3-5, Amherst, NY, 14228-2795
Phone Number
716-589-1411
Fax Number
716-276-3051
Provider Enumeration Date
06/28/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
1412 Sweet Home Rd Ste 3-5
City
Amherst
State
New York
Zip
14228-2795
Phone Number
716-589-1411
Fax Number
716-276-3051
person
Provider Business Mailing Address Details
Address
1412 Sweet Home Rd Ste 3-5
City
Amherst
State
New York
Zip
14228-2795
Phone Number
716-589-1411
Fax Number
716-276-3051
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Peer Specialist
Speciality
-
Taxonomy
175T00000X
License No.
()
Definition
Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.
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