Provider Demographics
NPI:1922158849
Name:SHETTSLINE, JAMES MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:SHETTSLINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:920 N BROAD ST STE 6
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2351
Mailing Address - Country:US
Mailing Address - Phone:215-855-4700
Mailing Address - Fax:215-361-9612
Practice Address - Street 1:920 N BROAD ST STE 6
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2351
Practice Address - Country:US
Practice Address - Phone:610-278-9741
Practice Address - Fax:610-272-0991
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2023-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS004848L207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE06280Medicare UPIN