Provider Demographics
NPI:1518609833
Name:SHATKIN, JARED ELLIS
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:ELLIS
Last Name:SHATKIN
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 1:89 BERESFORD CT # 2007
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5955
Mailing Address - Country:US
Mailing Address - Phone:716-310-0322
Mailing Address - Fax:
Practice Address - Street 1:2500 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14226-4927
Practice Address - Country:US
Practice Address - Phone:716-553-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program