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NPI Code Detail

MEDICARE: SHATARIA FLYE

MEDICARE: SHATARIA FLYE
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
1363LF0000XFamily Nurse PractitionerF09251330MO

General Provider Information

NPI Number : 1861345340
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHATARIA FLYE
Provider Business Mailing Address
First Line : 1304 GRAY ST
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-2512
Country : US
Telephone Number : 573-714-6920
Fax Number :
Provider Business Practice Location Address
First Line : 1500 N WESTWOOD BLVD
Second Line :
City : POPLAR BLUFF
State : MO
Zip : 63901-3318
Country : US
Telephone Number : 573-686-4151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ SHATARIA FLYE ” Practice Location

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