Provider Demographics
NPI:1871246694
Name:PASHUTA, SHANA PASHUTA (LPN)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:PASHUTA
Last Name:PASHUTA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:KOPPEL
Mailing Address - State:PA
Mailing Address - Zip Code:16136-0443
Mailing Address - Country:US
Mailing Address - Phone:724-939-0571
Mailing Address - Fax:
Practice Address - Street 1:900 SAHARA TRL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-3667
Practice Address - Country:US
Practice Address - Phone:330-267-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.180010.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse