=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245199223
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAUNA MARIE SCUTELLA PHMNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2026
-----------------------------------------------------
Last Update Date | 01/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 GILLIS AVE
-----------------------------------------------------
City | RIDGWAY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15853-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-772-5741
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1405 BUCKTAIL RD
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15857-3213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-594-6457
-----------------------------------------------------
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 | SP034840
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------