Provider Demographics
NPI:1710162805
Name:SHEARN, GLENDA A (PA)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:A
Last Name:SHEARN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 BEEKMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1506
Mailing Address - Country:US
Mailing Address - Phone:914-310-0493
Mailing Address - Fax:914-667-6887
Practice Address - Street 1:1010 HAZEN ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1399
Practice Address - Country:US
Practice Address - Phone:718-546-6245
Practice Address - Fax:718-546-5951
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant