Provider Demographics
NPI:1215133947
Name:SHADE, STEVEN C (MS, ATC)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:C
Last Name:SHADE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 LORD BYRON LN
Mailing Address - Street 2:APT. T4
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3544
Mailing Address - Country:US
Mailing Address - Phone:570-772-2223
Mailing Address - Fax:
Practice Address - Street 1:8000 YORK RD
Practice Address - Street 2:SPORTS MEDICINE - FIELD HOUSE 101D
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21252-0001
Practice Address - Country:US
Practice Address - Phone:410-704-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer