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General NPI Number Information
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NPI Number | 1629041744
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Entity Type | Individual
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Provider Name | BEVERLEY JEANNE SHEARES MD, MS
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Gender | Female
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 333 CEDAR ST
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City | NEW HAVEN
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State | CT
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Zip | 06510
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Country | US
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Telephone | 32-785-2480
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Fax | 203-785-6337
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Provider Business Mailing Address
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Address Line | 333 CEDAR STREET PO BOX 208064, LMP3096A
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City | NEW HAVEN
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State | CT
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Zip | 06520
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Country | US
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Telephone | 32-785-2480
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Fax | 203-785-6337
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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 | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 182028
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0214X
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Taxonomy Name | Pediatric Pulmonology Physician
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License Number | 60460
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License Number State | CT
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