Basic Information
| Provider Information | |||||||||
| NPI: | 1770721433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIRE-MISNIK | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 UNIVERSITY DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NEWTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189401873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157105522 | ||||||||
| FaxNumber: | 2157105181 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 INTERPLEX DR | ||||||||
| Address2: | |||||||||
| City: | TREVOSE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190536943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679917601 | ||||||||
| FaxNumber: | 2679917618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2009 | ||||||||
| LastUpdateDate: | 11/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | UP006975C | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 30205734 | 01 | PA | KEYSTONE FIRST | OTHER | 3931789000 | 01 | PA | KEYSTONE IBC | OTHER | 4692564 | 01 | PA | AETNA | OTHER | P01404986 | 01 | PA | RAILROAD MEDICARE | OTHER | 2842578 | 01 | PA | CIGNA PA | OTHER | 1030059990001 | 05 | PA | MEDICAID | 3078467 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |