Provider Demographics
NPI:1801638119
Name:SHEARS, ALEXIS (FMD, BCDNM, PHD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:SHEARS
Suffix:
Gender:
Credentials:FMD, BCDNM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 FLINT LOCK LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1621 FLINT LOCK LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9122
Practice Address - Country:US
Practice Address - Phone:260-479-0131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach