Provider Demographics
NPI:1952980427
Name:BIERLY, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:BIERLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 PELLETIER LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-7473
Mailing Address - Country:US
Mailing Address - Phone:252-503-1299
Mailing Address - Fax:
Practice Address - Street 1:424 PELLETIER LOOP RD
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-7473
Practice Address - Country:US
Practice Address - Phone:252-503-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty