Provider Demographics
NPI:1790423507
Name:ABATECOLA, SHANNON YAFFE (EDS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:YAFFE
Last Name:ABATECOLA
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 UNION HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-4042
Mailing Address - Country:US
Mailing Address - Phone:434-946-9700
Mailing Address - Fax:434-946-7050
Practice Address - Street 1:575 UNION HILL RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-4042
Practice Address - Country:US
Practice Address - Phone:434-946-9700
Practice Address - Fax:434-946-7050
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPGP-373382103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool