Provider Demographics
NPI:1063935542
Name:SHEBACLO, KAREEN (MD)
Entity type:Individual
Prefix:
First Name:KAREEN
Middle Name:
Last Name:SHEBACLO
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 1:840 WALNUT ST STE 910
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3250
Mailing Address - Fax:215-928-3276
Practice Address - Street 1:840 WALNUT ST STE 910
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3250
Practice Address - Fax:215-928-3276
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125.071383207L00000X
PAMD478276207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery