Provider Demographics
NPI:1780601112
Name:SIRMANS-MCRAE, SHINETTE (MD)
Entity type:Individual
Prefix:
First Name:SHINETTE
Middle Name:
Last Name:SIRMANS-MCRAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHINETTE
Other - Middle Name:
Other - Last Name:SIRMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14 BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-2004
Mailing Address - Country:US
Mailing Address - Phone:609-912-0180
Mailing Address - Fax:
Practice Address - Street 1:15 CAMPUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3200
Practice Address - Country:US
Practice Address - Phone:484-454-6262
Practice Address - Fax:610-789-6158
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07699300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2022245OtherHIGHMARK BLUE SHIELD
PA3436078000OtherKEYSTONE HEALTH PLAN EAST
PA101902511 0001Medicaid
PA30060749OtherKEYSTONE MERCY-LOWER BUCKS GROUP
PA111756ZCHMMedicare PIN
PA3436078000OtherKEYSTONE HEALTH PLAN EAST
PA111756ZDKTMedicare PIN