Healthcare Provider Details

I. General information

NPI: 1982802104
Provider Name (Legal Business Name): SHAUNA WEISE BOMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAUNA LYNN WEISE M.D.

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-1455
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMT191747
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD442209
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: