Healthcare Provider Details

I. General information

NPI: 1104229046
Provider Name (Legal Business Name): MRS. KASHARA JANELLE WHEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 S WATER ST APT 201
PITTSBURGH PA
15203-4003
US

IV. Provider business mailing address

3030 S WATER ST APT 201
PITTSBURGH PA
15203-4003
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-4834
  • Fax:
Mailing address:
  • Phone: 571-992-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number06034834
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: