Provider Demographics
NPI:1316558596
Name:SHECTMAN, JONATHAN ADAR (NP)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ADAR
Last Name:SHECTMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W AVENUE Q STE AC
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3893
Mailing Address - Country:US
Mailing Address - Phone:661-949-8643
Mailing Address - Fax:
Practice Address - Street 1:647 W AVENUE Q STE AC
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3893
Practice Address - Country:US
Practice Address - Phone:661-949-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65063363LA2200X, 363LF0000X
CA95018983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health