Provider Demographics
NPI:1558469080
Name:SHEARER, STEPHANIE DIANE (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DIANE
Last Name:SHEARER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DIANE
Other - Last Name:MCMULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1970 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1002
Mailing Address - Country:US
Mailing Address - Phone:215-368-1900
Mailing Address - Fax:215-368-8772
Practice Address - Street 1:1970 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1002
Practice Address - Country:US
Practice Address - Phone:215-368-1900
Practice Address - Fax:215-368-8772
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022761370001Medicaid
PAOS013184OtherSTATE LICENSE
PAOS013184OtherSTATE LICENSE