Provider Demographics
NPI:1962994624
Name:SHETAYH, BRONSON Z (MD)
Entity type:Individual
Prefix:
First Name:BRONSON
Middle Name:Z
Last Name:SHETAYH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 FIR DR
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-9585
Mailing Address - Country:US
Mailing Address - Phone:610-573-0274
Mailing Address - Fax:
Practice Address - Street 1:2830 EASTON AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-4204
Practice Address - Country:US
Practice Address - Phone:484-526-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine