| Doctor Name: | MRS. SHAYNE KING DOUGHERTY |
| NPI Number: | 1154358752 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | SP007565 |
| Business Practice Address: | 32 Greenview Ln Havertown, PA - 190834313 |
| Business Phone Number: | 6109249763 |
| Business Fax Number: | |
| Mailing Address: | 3400 Civic Center Blvd., PHILADELPHIA |
| State: | PA |
| Postal Code: | 191044399 |
| Phone Number: | 2674265112 |
| Fax Number: | 2155903053 |
| NPI Enumeration Date: | 06/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | SP007565 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |