Provider Demographics
NPI:1760745707
Name:PEARSON, SHAYLA J (APN)
Entity Type:Individual
Prefix:
First Name:SHAYLA
Middle Name:J
Last Name:PEARSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SHAYLA
Other - Middle Name:J
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:765 ROUTE 70 E BLDG A-101
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 WOODBURY TURNERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-374-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP01187363LP0808X
NJ26NJ00383900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health