Provider Demographics
NPI:1124730791
Name:TATE, SHANERHA (CRNP, WHNP-BC)
Entity type:Individual
Prefix:MS
First Name:SHANERHA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:CRNP, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S LANSDOWNE AVE APT E7
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2427
Mailing Address - Country:US
Mailing Address - Phone:267-368-0063
Mailing Address - Fax:
Practice Address - Street 1:5800 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3836
Practice Address - Country:US
Practice Address - Phone:215-474-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026420363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology