Provider Demographics
NPI:1437780855
Name:SHEVLIN, TIMOTHY JAY JR
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAY
Last Name:SHEVLIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2657
Mailing Address - Country:US
Mailing Address - Phone:267-374-2564
Mailing Address - Fax:
Practice Address - Street 1:953 DANBY RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-7002
Practice Address - Country:US
Practice Address - Phone:267-374-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program