Healthcare Provider Details

I. General information

NPI: 1942662341
Provider Name (Legal Business Name): KIMBERLY SHEMANSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RENAISSANCE SQUARE, 141 ROUTE 70, SUITE C
MARLTON NJ
08053
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7176
  • Fax: 856-762-1249
Mailing address:
  • Phone: 856-355-7176
  • Fax: 856-762-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA12308000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: