Healthcare Provider Details

I. General information

NPI: 1447287321
Provider Name (Legal Business Name): SUZETTE M SHEARS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 SANDY LN SUITE 270
LEWISTOWN PA
17044-1310
US

IV. Provider business mailing address

27 SANDY LN SUITE 270
LEWISTOWN PA
17044-1310
US

V. Phone/Fax

Practice location:
  • Phone: 717-242-7332
  • Fax: 717-242-7375
Mailing address:
  • Phone: 717-242-7332
  • Fax: 717-242-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA003344L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: