Provider Demographics
NPI:1740210210
Name:SHOLLENBERGER, JENNIFER LYNN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:SHOLLENBERGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:SUNDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:888 WORCESTER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3744
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:12 PENNS TRAIL
Practice Address - Street 2:SUITE 154
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3438
Practice Address - Country:US
Practice Address - Phone:215-675-3005
Practice Address - Fax:888-662-0859
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004171L213E00000X
NJ25MD00233300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016586610006Medicaid
PA0429099000OtherKEYSTONE HEALTH PLAN EAST
PA965457OtherHIGHMARK BLUE SHIELD
NJ7337205Medicaid
PA480023686OtherMEDICARE RAILROAD
PAU57946Medicare UPIN
PA0429099000OtherKEYSTONE HEALTH PLAN EAST
PA901415LAEMedicare ID - Type Unspecified