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General NPI Number Information
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NPI Number | 1043557861
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Entity Type | Individual
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Provider Name | JEFFREY LEE SHRALOW PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/14/2013
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 19409 PLANTATION RD STE 4
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City | REHOBOTH BEACH
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State | DE
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Zip | 19971-4493
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Country | US
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Telephone | 215-292-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 893 N BUCKNELL ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-1934
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Country | US
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Telephone | 215-292-0307
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP012679
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | L8-0010448
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License Number State | DE
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