Basic Information
| Provider Information | |||||||||
| NPI: | 1891159786 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | SHEENA | ||||||||
| MiddleName: | AMIE | ||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | THOMAS | ||||||||
| OtherFirstName: | SHEENA | ||||||||
| OtherMiddleName: | AMIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2500 MARYLAND RD STE 504 | ||||||||
| Address2: | |||||||||
| City: | WILLOW GROVE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190901226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154816872 | ||||||||
| FaxNumber: | 2154813985 | ||||||||
| Practice Location | |||||||||
| Address1: | 10800 KNIGHTS RD | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156124000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA060441 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 0110005304 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.