Provider Demographics
NPI:1346546090
Name:DONAHUE, ULRIKE SHAON (DO)
Entity Type:Individual
Prefix:
First Name:ULRIKE
Middle Name:SHAON
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 DELAWARE ST
Mailing Address - Street 2:STE 1
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2764
Mailing Address - Country:US
Mailing Address - Phone:801-601-3113
Mailing Address - Fax:814-601-3114
Practice Address - Street 1:51 DELAWARE ST
Practice Address - Street 2:STE 1
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2764
Practice Address - Country:US
Practice Address - Phone:801-601-3113
Practice Address - Fax:814-601-3114
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT01795207Q00000X
PAOS015888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA236011OtherMEDICARE PTAN
PA102685853Medicaid