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Individual

SHANNON DOYLE TIEDEKEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
101 APPLIED BANK BLVD STE 11, NEMOURS DUPONT PEDIATRICS, GLEN MILLS URGENT CARE, GLEN MILLS, PA 19342-3501
(484) 800-8630
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD454113
PA

Other

Enumeration date
04/18/2012
Last updated
03/17/2017
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