Provider Demographics
NPI:1013649086
Name:SHULTZ, JEREMIAH DAVID
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:DAVID
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 TALIAFERRO DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-5629
Mailing Address - Country:US
Mailing Address - Phone:540-820-3781
Mailing Address - Fax:
Practice Address - Street 1:910 TALIAFERRO DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-5629
Practice Address - Country:US
Practice Address - Phone:540-820-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty