MEDICARE: SHATARA NICOLE AMEY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	RN705022	PA

General Provider Information

NPI Number	:	1336733377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATARA NICOLE AMEY RN

Provider Business Mailing Address
First Line	:	329 SHENANDOAH DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-2056
Country	:	US
Telephone Number	:	412-708-0147
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 SHENANDOAH DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-2056
Country	:	US
Telephone Number	:	412-708-0147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2021
Last Update Date	:	02/20/2021

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