Healthcare Provider Details

I. General information

NPI: 1588423099
Provider Name (Legal Business Name): SHIMA EBED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HAWK RIDGE DR
HAMBURG PA
19526-9219
US

IV. Provider business mailing address

78 EALING DR
IOWA CITY IA
52246-4720
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-8000
  • Fax:
Mailing address:
  • Phone: 319-382-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberHS000009L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: