=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013702422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSSA SHELUGA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 MAPLE AVE STE 6
-----------------------------------------------------
City | HONESDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18431-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-253-8219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 805 N MAIN AVE
-----------------------------------------------------
City | SCRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18504-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-335-3396
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | SP032702
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------