Provider Demographics
NPI:1639132426
Name:SHEKARI, TIANA (DO)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:
Last Name:SHEKARI
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 1:801 OSTRUM ST
Mailing Address - Street 2:ENROLLMENT CENTER
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:610-814-2424
Mailing Address - Fax:610-814-2425
Practice Address - Street 1:4379 EASTON AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-1483
Practice Address - Country:US
Practice Address - Phone:610-814-2424
Practice Address - Fax:610-814-2425
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014589300002Medicaid
PAI25573Medicare UPIN
PA1014589300002Medicaid