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NPI Code Detail

MEDICARE: ERICA SHATARA DO

MEDICARE: ERICA SHATARA DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician289418-1NY

General Provider Information

NPI Number : 1386059525
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA SHATARA DO
Provider Business Mailing Address
First Line : 1 GUTHRIE SQ
Second Line :
City : SAYRE
State : PA
Zip : 18840-1625
Country : US
Telephone Number : 570-888-5858
Fax Number :
Provider Business Practice Location Address
First Line : 1336 CEDAR ST
Second Line :
City : ELMIRA
State : NY
Zip : 14904-2951
Country : US
Telephone Number : 607-734-3929
Fax Number : 570-887-6820
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2014
Last Update Date : 03/24/2021

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