Healthcare Provider Details

I. General information

NPI: 1427806314
Provider Name (Legal Business Name): AUTUMN SHAUB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11883 PERRY HWY
WEXFORD PA
15090-7353
US

IV. Provider business mailing address

205 NOEL CREST DR
MARS PA
16046-7117
US

V. Phone/Fax

Practice location:
  • Phone: 724-987-2993
  • Fax:
Mailing address:
  • Phone: 412-980-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: