Provider Demographics
NPI:1912631813
Name:SHANEYFELT-JARZYNSKI, MICHELLE RAE (CRNP-PMHNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAE
Last Name:SHANEYFELT-JARZYNSKI
Suffix:
Gender:F
Credentials:CRNP-PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 HARKINS RD
Mailing Address - Street 2:
Mailing Address - City:PYLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21132-1623
Mailing Address - Country:US
Mailing Address - Phone:410-652-6701
Mailing Address - Fax:
Practice Address - Street 1:200 BOOTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5657
Practice Address - Country:US
Practice Address - Phone:410-996-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165964363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health