Healthcare Provider Details

I. General information

NPI: 1508559501
Provider Name (Legal Business Name): JENNIFER ANN SHATTAHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WELLNESS WAY STE 300
WASHINGTON PA
15301-9697
US

IV. Provider business mailing address

243 THREE SPRINGS DR STE 5A
WEIRTON WV
26062-3839
US

V. Phone/Fax

Practice location:
  • Phone: 740-792-4220
  • Fax: 740-275-4472
Mailing address:
  • Phone: 407-792-4220
  • Fax: 740-275-4472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN318643
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN593074
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0034383
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: