Provider Demographics
NPI:1700698685
Name:MCILVAIN, SHAWN JUDE (CRNP)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:JUDE
Last Name:MCILVAIN
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3234 PEBBLEWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:DRESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19025
Mailing Address - Country:US
Mailing Address - Phone:215-934-1072
Mailing Address - Fax:
Practice Address - Street 1:827 GLENSIDE AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095
Practice Address - Country:US
Practice Address - Phone:215-392-2892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0010GI2207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine