Basic Information
Provider Information
NPI: 1114056884
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHEFFLER
FirstName: BROOKE
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 785 5TH AVE
Address2: SUITE 3
City: CHAMBERSBURG
State: PA
PostalCode: 172014232
CountryCode: US
TelephoneNumber: 7172639555
FaxNumber: 7172174218
Practice Location
Address1: 1000 NORLAND AVE
Address2:  
City: CHAMBERSBURG
State: PA
PostalCode: 172014229
CountryCode: US
TelephoneNumber: 7172676363
FaxNumber: 7172176937
Other Information
ProviderEnumerationDate: 03/05/2007
LastUpdateDate: 04/07/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/07/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X35.096843OHN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000XMD451393PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
86763301PAMEDICARE GROUP #OTHER
10296951505PA MEDICAID


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