Provider Demographics
NPI:1124245238
Name:NEYHART, SHIRLEY A (NP)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:A
Last Name:NEYHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHILREY
Other - Middle Name:
Other - Last Name:LOUISSAINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:21 BRAMBLE BUSH DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-495-5160
Mailing Address - Fax:
Practice Address - Street 1:21 BRAMBLE BUSH DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-495-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260865163W00000X
MARN260865363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse