Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shirley Prasetyo Buntoro, DO

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1831727239

Shirley Prasetyo Buntoro, DO is a Family Practice in Sayre, Pennsylvania. Qualified in 2020, 6 years ago. Practices with Christus Trinity Clinic, a 1,531-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Texas.

Years since qualifying
6
Licensed in
TX
In the registry since
2020
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

1 Guthrie Sq
Sayre, PA 18840-1625
Phone: (570) 887-3585
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3802 Manhatton Dr, Tyler, TX 75701-9451 — (903) 509-8888

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence U4752 (TX)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1831727239
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorYes
NPI enumeratedMarch 31, 2020
Last updated in NPPESJuly 19, 2023
Certification dateJuly 19, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Christus Trinity Clinic — 1531 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

Other providers in Sayre