Provider Demographics
NPI:1447287321
Name:SHEARS, SUZETTE M (PA-C)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:M
Last Name:SHEARS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 SANDY LN
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-1310
Mailing Address - Country:US
Mailing Address - Phone:717-242-7332
Mailing Address - Fax:717-242-7375
Practice Address - Street 1:27 SANDY LN
Practice Address - Street 2:SUITE 270
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1310
Practice Address - Country:US
Practice Address - Phone:717-242-7332
Practice Address - Fax:717-242-7375
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003344L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P11758Medicare UPIN
PA040777Medicare ID - Type Unspecified