Provider Demographics
NPI:1821433616
Name:SHEARER, DANE (CPT, CMES, LWMC)
Entity Type:Individual
Prefix:
First Name:DANE
Middle Name:
Last Name:SHEARER
Suffix:
Gender:M
Credentials:CPT, CMES, LWMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10460 QUEENS BLVD APT 15C
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7309
Mailing Address - Country:US
Mailing Address - Phone:843-860-3064
Mailing Address - Fax:
Practice Address - Street 1:2313 SNAPDRAGON PT
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9397
Practice Address - Country:US
Practice Address - Phone:843-860-3064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86078718133V00000X
133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered