Provider Demographics
NPI:1023146693
Name:SHAY, LYNN ELLEN (CPM, CRNP)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ELLEN
Last Name:SHAY
Suffix:
Gender:F
Credentials:CPM, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ANTHONYS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BARTO
Mailing Address - State:PA
Mailing Address - Zip Code:19504-8811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1220 VALLEY FORGE RD STE 35
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2676
Practice Address - Country:US
Practice Address - Phone:610-933-1688
Practice Address - Fax:610-983-0698
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
PASP009361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
120904V0UMedicare PIN