Provider Demographics
NPI:1346505302
Name:MOORE, SHANDA (APN)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BRACE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2624
Mailing Address - Country:US
Mailing Address - Phone:856-428-4100
Mailing Address - Fax:856-428-5748
Practice Address - Street 1:1 BRACE RD
Practice Address - Street 2:SUITE C
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-2624
Practice Address - Country:US
Practice Address - Phone:856-428-4100
Practice Address - Fax:856-428-5748
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00385400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health