Provider Demographics
NPI:1770721433
Name:SHIRE-MISNIK, SHERRY L (CRNP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:SHIRE-MISNIK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:2500 INTERPLEX DR
Practice Address - Street 2:
Practice Address - City:TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6943
Practice Address - Country:US
Practice Address - Phone:267-991-7601
Practice Address - Fax:267-991-7618
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006975C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30205734OtherKEYSTONE FIRST
PA3931789000OtherKEYSTONE IBC
PA4692564OtherAETNA
PAP01404986OtherRAILROAD MEDICARE
PA2842578OtherCIGNA PA
PA1030059990001Medicaid
PA3078467OtherHIGHMARK BLUE SHIELD
PA146958R52Medicare PIN