Provider Demographics
NPI:1447458344
Name:SHOREMAN, JENNIFER MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:SHOREMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13625 GOLDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9648
Mailing Address - Country:US
Mailing Address - Phone:317-531-8660
Mailing Address - Fax:
Practice Address - Street 1:1201 DUBLIN RD PMB #647
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1045
Practice Address - Country:US
Practice Address - Phone:415-735-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT76870207R00000X, 208000000X
ALMD.48681207R00000X, 208000000X
NH25475207R00000X, 208000000X
MEMD27932207R00000X, 208000000X
KY48035207R00000X, 208000000X
IN01071277A207R00000X, 208000000X
OH35.099744208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics