Healthcare Provider Details

I. General information

NPI: 1619156312
Provider Name (Legal Business Name): SHEELA THOMAS GEORGE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 BYBERRY RD STE 1203
HUNTINGDON VALLEY PA
19006-3524
US

IV. Provider business mailing address

140 W GERMANTOWN PIKE STE 250
PLYMOUTH MEETING PA
19462-1421
US

V. Phone/Fax

Practice location:
  • Phone: 215-517-1100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP004740X
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: