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General NPI Number Information
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NPI Number | 1336632587
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Entity Type | Individual
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Provider Name | ANDREA M SHAUL CPNP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 639 MAIN ST
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1805
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Country | US
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Telephone | 607-770-1988
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Fax | 607-770-1988
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Provider Business Mailing Address
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Address Line | 71 HOSPITAL DR
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City | TOWANDA
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State | PA
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Zip | 18848-9702
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Country | US
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Telephone | 570-265-6300
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Fax | 570-268-2807
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP017960
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F382793-1
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License Number State | NY
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