Individual
TAE I SHYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
980 SUTTON RD, SHAVERTOWN, PA 18708-9471
(570) 690-4527
Mailing address
980 SUTTON RD, SHAVERTOWN, PA 18708-9471
(570) 690-4527
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD036509L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000213215
UNISON
PA
05
—
0005531730002
—
PA
Enumeration date
09/01/2005
Last updated
02/07/2020
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