Provider Demographics
NPI:1639388598
Name:DAUGHERTY, SHACORA
Entity Type:Individual
Prefix:MS
First Name:SHACORA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 BENJAMIN FRANKLIN PKWY
Mailing Address - Street 2:APT#E308
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3601
Mailing Address - Country:US
Mailing Address - Phone:215-670-9555
Mailing Address - Fax:215-546-1633
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4719
Practice Address - Country:US
Practice Address - Phone:215-670-5956
Practice Address - Fax:215-546-1633
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator