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General NPI Number Information
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NPI Number | 1770124661
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Entity Type | Individual
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Provider Name | SHEILA MARIE CLARK
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Gender | Female
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Dates
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Enumeration Date | 10/02/2019
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 136 ROUTE 73 STE A
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City | VOORHEES
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State | NJ
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Zip | 08043-9598
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Country | US
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Telephone | 877-388-2778
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Fax | 856-424-7529
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Provider Business Mailing Address
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Address Line | 1 DIAMOND HILL RD
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City | BERKELEY HEIGHTS
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State | NJ
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Zip | 07922-2104
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Country | US
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Telephone | 908-273-4300
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN689688
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NJ15032300
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License Number State | NJ
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