MEDICARE: DR. SHYRELLE GARDNER M.D.

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	207R00000X	Internal Medicine Physician	MD030003E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710948609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHYRELLE GARDNER M.D.

Provider Business Mailing Address
First Line	:	333 W MOUNT PLEASANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2904
Country	:	US
Telephone Number	:	215-247-3300
Fax Number	:	216-247-0799

Provider Business Practice Location Address
First Line	:	333 W MOUNT PLEASANT AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2904
Country	:	US
Telephone Number	:	215-247-3300
Fax Number	:	216-247-0799

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	06/05/2019

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