Provider Demographics
NPI:1285014605
Name:REARDEN, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:REARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7174 GLENMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-1828
Mailing Address - Country:US
Mailing Address - Phone:570-898-0344
Mailing Address - Fax:
Practice Address - Street 1:7174 GLENMEADOW CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-1828
Practice Address - Country:US
Practice Address - Phone:570-898-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant