Basic Information
Provider Information
NPI: 1588054928
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHEARER
FirstName: DANIEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AUD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3855 W CHESTER PIKE
Address2: SUITE 280
City: NEWTOWN SQUARE
State: PA
PostalCode: 190732304
CountryCode: US
TelephoneNumber: 6105574800
FaxNumber: 3026514945
Practice Location
Address1: 3855 W CHESTER PIKE
Address2: SUITE 280
City: NEWTOWN SQUARE
State: PA
PostalCode: 190732304
CountryCode: US
TelephoneNumber: 6105574800
FaxNumber: 3026514945
Other Information
ProviderEnumerationDate: 01/23/2015
LastUpdateDate: 02/04/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XO2 0000208DEN Speech, Language and Hearing Service ProvidersAudiologist 
231H00000XAT006369PAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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