Healthcare Provider Details

I. General information

NPI: 1164931630
Provider Name (Legal Business Name): SHEETAL J GADE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CORNERSTONE DR STE B
MOUNT JOY PA
17552-9416
US

IV. Provider business mailing address

582 ROYER DR
LANCASTER PA
17601-5186
US

V. Phone/Fax

Practice location:
  • Phone: 717-653-2929
  • Fax: 717-492-0699
Mailing address:
  • Phone: 717-824-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018080
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: