Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0214X | Pediatric Pulmonologist | 182028 | NY |
Y | 2080P0214X | Pediatric Pulmonologist | 60460 | CT |
NPI | 1629041744 |
---|---|
Provider Name | Beverley Jeanne Sheares |
First Address | New Haven, CT 06520 |
Second Address | New Haven, CT 06510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 29/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01187719 | (05) | NY |
E74235 | (02) | NY |