Provider Demographics
NPI:1063548485
Name:SHIRK, DAISY (DO)
Entity type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:SHIRK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-4734
Practice Address - Fax:717-782-4727
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008002-L2084P0800X
PAOS-008202-L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01740401OtherCBC PROVIDER ID
PA278630OtherHIGHMARK PROVIDER ID
PA20-5545244OtherEIN NUMBER
PA278630OtherHIGHMARK PROVIDER ID