Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD464339 | PA |
NPI | 1164788832 |
---|---|
Provider Name | Julie Shaner |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19140-4105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2012 |
Last Update Date | 19/05/2020 |