Provider Demographics
NPI:1619090768
Name:JAGIELLO, SHAHNAZ (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHAHNAZ
Middle Name:
Last Name:JAGIELLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20399 ROUTE 19
Mailing Address - Street 2:SUITE 203, ONE LANDMARK NORTH
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6134
Mailing Address - Country:US
Mailing Address - Phone:724-772-8000
Mailing Address - Fax:724-772-8040
Practice Address - Street 1:20399 ROUTE 19
Practice Address - Street 2:SUITE 203, ONE LANDMARK NORTH
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6134
Practice Address - Country:US
Practice Address - Phone:724-772-8000
Practice Address - Fax:724-772-8040
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001051L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15139OtherELDER HEALTH PROVIDER
PA095934QYEMedicare ID - Type Unspecified
PA15139OtherELDER HEALTH PROVIDER