Provider Demographics
NPI:1629041744
Name:SHEARES, BEVERLEY JEANNE (MD, MS)
Entity Type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:JEANNE
Last Name:SHEARES
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CEDAR STREET
Mailing Address - Street 2:PO BOX 208064, LMP3096A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520
Mailing Address - Country:US
Mailing Address - Phone:032-785-2480
Mailing Address - Fax:203-785-6337
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:032-785-2480
Practice Address - Fax:203-785-6337
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1820282080P0214X
CT604602080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01187719Medicaid
NY01187719Medicaid
NYE74235Medicare UPIN