Individual
TIMOTHY R SHADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 887-2383
(570) 887-3285
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
(570) 887-3023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
F342441-1
NY
363L00000X
Nurse Practitioner
Primary
SP018240
PA
Other
Enumeration date
06/09/2017
Last updated
03/08/2021
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