Healthcare Provider Details

I. General information

NPI: 1891046348
Provider Name (Legal Business Name): CHAYA SHUCHAT CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2012
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E BROAD ST
HAZLETON PA
18201-5657
US

IV. Provider business mailing address

1730 E BROAD ST
HAZLETON PA
18201-5657
US

V. Phone/Fax

Practice location:
  • Phone: 570-704-4648
  • Fax:
Mailing address:
  • Phone: 570-704-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP15918
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: