Provider Demographics
NPI:1700328960
Name:MOORE, SHARDELL ELYN (NP)
Entity Type:Individual
Prefix:
First Name:SHARDELL
Middle Name:ELYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PRESIDENTIAL WAY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1100
Mailing Address - Country:US
Mailing Address - Phone:180-091-9910
Mailing Address - Fax:
Practice Address - Street 1:1601 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19192-0003
Practice Address - Country:US
Practice Address - Phone:180-091-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily