Provider Demographics
NPI:1912454273
Name:FLISZAR, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:FLISZAR
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 1:9299 LYON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW TRIPOLI
Mailing Address - State:PA
Mailing Address - Zip Code:18066-3049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9299 LYON VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-3049
Practice Address - Country:US
Practice Address - Phone:484-264-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-04
Last Update Date:2016-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer