1366519548 NPI number — AMY G SHEFFIELD O.D.

Table of content: AMY G SHEFFIELD O.D. (NPI 1366519548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366519548 NPI number — AMY G SHEFFIELD O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEFFIELD
Provider First Name:
AMY
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366519548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 PHEASANT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-222-4850
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 FAIRVIEW BLVD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DELRAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08075-1472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-829-5212
Provider Business Practice Location Address Fax Number:
856-829-1105
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NJ5065 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 631823 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 631823 . This is a "OPTICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0461777000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ5065 . This is a "EYE MED" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223131493 . This is a "HORIZON BLUE CROSS SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 37063 . This is a "DAVIS VISION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 311132 . This is a "NVA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 11530 . This is a "SPECTERA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 17155 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3058212 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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