Provider Demographics
NPI:1942795844
Name:SHEARMAN, ALI
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SHEARMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 ROUND TOWER DR E
Mailing Address - Street 2:
Mailing Address - City:COTTLEVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63304-0814
Mailing Address - Country:US
Mailing Address - Phone:636-544-3830
Mailing Address - Fax:
Practice Address - Street 1:3009 N BALLAS RD STE 300A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2354
Practice Address - Country:US
Practice Address - Phone:314-997-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018018096363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant