Provider Demographics
NPI:1942411756
Name:SHELL, JEROME W II
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:W
Last Name:SHELL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3226
Mailing Address - Country:US
Mailing Address - Phone:724-437-2081
Mailing Address - Fax:724-437-4095
Practice Address - Street 1:164 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3226
Practice Address - Country:US
Practice Address - Phone:724-437-2081
Practice Address - Fax:724-437-4095
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011546L176P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176P00000XOther Service ProvidersFuneral Director