Provider Demographics
NPI:1821816216
Name:SHATKIN, OLGA Y (APN)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:Y
Last Name:SHATKIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BERDAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3210
Mailing Address - Country:US
Mailing Address - Phone:973-692-9780
Mailing Address - Fax:
Practice Address - Street 1:87 BERDAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3210
Practice Address - Country:US
Practice Address - Phone:973-692-9780
Practice Address - Fax:973-832-7901
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15141000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology