Healthcare Provider Details

I. General information

NPI: 1194926360
Provider Name (Legal Business Name): JONATHAN SHIREY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RUTHERFORD RD STE 101
HARRISBURG PA
17109-4540
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-545-5256
  • Fax: 717-545-5259
Mailing address:
  • Phone: 717-270-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT190918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: