Healthcare Provider Details

I. General information

NPI: 1861039182
Provider Name (Legal Business Name): SHANNON MOYER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N BROAD ST
LANSDALE PA
19446-2411
US

IV. Provider business mailing address

311 N BROAD ST STE 400
LANSDALE PA
19446-2411
US

V. Phone/Fax

Practice location:
  • Phone: 215-855-2424
  • Fax:
Mailing address:
  • Phone: 215-855-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSP032532
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberSP032532
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: