Basic Information
| Provider Information | |||||||||
| NPI: | 1588061931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EXIME | ||||||||
| FirstName: | SHERLEY | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASSEUS | ||||||||
| OtherFirstName: | SHERLEY | ||||||||
| OtherMiddleName: | LISA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2030 THISTLE HILL DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPRING GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173621159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172259869 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2030 THISTLE HILL DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SPRING GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173621159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172259869 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2014 | ||||||||
| LastUpdateDate: | 12/12/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.