Provider Demographics
NPI:1508559501
Name:SHATTAHI, JENNIFER ANN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:SHATTAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 THREE SPRINGS DR STE 5A
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3839
Mailing Address - Country:US
Mailing Address - Phone:407-792-4220
Mailing Address - Fax:740-275-4472
Practice Address - Street 1:240 WELLNESS WAY STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9697
Practice Address - Country:US
Practice Address - Phone:740-792-4220
Practice Address - Fax:740-275-4472
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN318643163W00000X
PARN593074163W00000X
OHAPRN.CNP.0034383363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse