Provider Demographics
NPI:1770545808
Name:SHADDUCK, SNEED PATRICK (MD)
Entity type:Individual
Prefix:
First Name:SNEED
Middle Name:PATRICK
Last Name:SHADDUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:610-743-6049
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:6TH AVENUE & SPRUCE STREET
Practice Address - Street 2:READING ANESTHESIA ASSOCIATES LTD
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-988-8589
Practice Address - Fax:610-988-5976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042683L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012407630001Medicaid
666127Medicare ID - Type Unspecified
PA0012407630001Medicaid