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General NPI Number Information
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NPI Number | 1508559501
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Entity Type | Individual
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Provider Name | JENNIFER ANN SHATTAHI
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Gender | Female
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 240 WELLNESS WAY STE 300
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City | WASHINGTON
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State | PA
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Zip | 15301-9697
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Country | US
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Telephone | 740-792-4220
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Fax | 740-275-4472
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Provider Business Mailing Address
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Address Line | 243 THREE SPRINGS DR STE 5A
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City | WEIRTON
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State | WV
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Zip | 26062-3839
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Country | US
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Telephone | 407-792-4220
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Fax | 740-275-4472
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN318643
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN593074
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN.CNP.0034383
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License Number State | OH
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