Healthcare Provider Details

I. General information

NPI: 1336733377
Provider Name (Legal Business Name): SHATARA NICOLE AMEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 SHENANDOAH DR
PITTSBURGH PA
15235-2056
US

IV. Provider business mailing address

329 SHENANDOAH DR
PITTSBURGH PA
15235-2056
US

V. Phone/Fax

Practice location:
  • Phone: 412-708-0147
  • Fax:
Mailing address:
  • Phone: 412-708-0147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN705022
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: