Provider Demographics
NPI:1053724955
Name:SHEARER, TRAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:SHEARER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 APPLEGATE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7985
Mailing Address - Country:US
Mailing Address - Phone:910-364-1633
Mailing Address - Fax:
Practice Address - Street 1:3954 APPLEGATE CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7985
Practice Address - Country:US
Practice Address - Phone:910-364-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical