Provider Demographics
NPI:1912299389
Name:SHEAFFER, ALYSIA J (CRNP)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:J
Last Name:SHEAFFER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:J
Other - Last Name:BRUNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1500 MARKET STREET
Mailing Address - Street 2:LM 500 WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2100
Mailing Address - Country:US
Mailing Address - Phone:215-985-2595
Mailing Address - Fax:
Practice Address - Street 1:1200 CALLOWHILL ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3658
Practice Address - Country:US
Practice Address - Phone:215-825-8220
Practice Address - Fax:215-825-8254
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily