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NPI Code Detail

MEDICARE: ELIZABETH JOAN SHANLEY PMHNP

MEDICARE: ELIZABETH JOAN SHANLEY PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95004901CA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerSP011605PA

General Provider Information

NPI Number : 1184998668
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH JOAN SHANLEY PMHNP
Provider Business Mailing Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 610-733-3799
Fax Number :
Provider Business Practice Location Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 610-733-3799
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2012
Last Update Date : 08/21/2023

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