Healthcare Provider Details

I. General information

NPI: 1346308640
Provider Name (Legal Business Name): HELEN KATHLEEN SHANTZ L.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 BABCOCK BLVD
PITTSBURGH PA
15237-2734
US

IV. Provider business mailing address

417 SOUTH OLIVER AVENUE
ZELIENOPLE PA
16063
US

V. Phone/Fax

Practice location:
  • Phone: 412-580-9128
  • Fax:
Mailing address:
  • Phone: 412-580-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberLC002526
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: