Provider Demographics
NPI:1063188894
Name:SHEARER, DOUGLAS (RN, BSN,BLS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:SHEARER
Suffix:
Gender:M
Credentials:RN, BSN,BLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KENT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:NY
Mailing Address - Zip Code:13135-2230
Mailing Address - Country:US
Mailing Address - Phone:315-560-3367
Mailing Address - Fax:
Practice Address - Street 1:20 KENT ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:NY
Practice Address - Zip Code:13135-2230
Practice Address - Country:US
Practice Address - Phone:315-560-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY593393163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice