MEDICARE: SHARDELL ELYN MOORE NP

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	363LF0000X	Family Nurse Practitioner	SP016238	PA

General Provider Information

NPI Number	:	1700328960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARDELL ELYN MOORE NP

Provider Business Mailing Address
First Line	:	150 PRESIDENTIAL WAY
Second Line	:	3RD FLOOR
City	:	WOBURN
State	:	MA
Zip	:	01801-1100
Country	:	US
Telephone Number	:	180-091-9910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CHESTNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19192-0003
Country	:	US
Telephone Number	:	180-091-9910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	11/04/2016

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