MEDICARE: THOMAS JEFFERSON UNIVERSITY

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
1	251K00000X	Public Health or Welfare Agency	820114	PA

General Provider Information

NPI Number	:	1285777409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS JEFFERSON UNIVERSITY

Provider Business Mailing Address
First Line	:	833 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4414
Country	:	US
Telephone Number	:	215-955-7910
Fax Number	:	215-503-2850

Provider Business Practice Location Address
First Line	:	1021 S 21ST ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-2634
Country	:	US
Telephone Number	:	215-790-9942
Fax Number	:	215-503-2850

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SARA M. SHANE
Credential	:	PSY.D.
Telephone Number	:	215-890-6268

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	01/07/2026

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