Healthcare Provider Details

I. General information

NPI: 1134802838
Provider Name (Legal Business Name): SHANIRA GARVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MEADOWOOD DR.
LANGHORNE PA
19047
US

IV. Provider business mailing address

10 MEADOWOOD DR
LANGHORNE PA
19047-2858
US

V. Phone/Fax

Practice location:
  • Phone: 215-750-4004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP032720
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NR27105700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number723724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: