Provider Demographics
NPI:1538106901
Name:SHIBUTANI, YASUSHI F (MD)
Entity Type:Individual
Prefix:
First Name:YASUSHI
Middle Name:F
Last Name:SHIBUTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 OLD YORK RD STE 218
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3841
Mailing Address - Country:US
Mailing Address - Phone:215-517-1100
Mailing Address - Fax:215-517-1130
Practice Address - Street 1:1800 BYBERRY RD STE 1203
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006
Practice Address - Country:US
Practice Address - Phone:215-517-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044369E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01625268Medicaid
F45958Medicare UPIN
PA432424U0AMedicare ID - Type Unspecified