Individual
JENNIFER SHATTUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 EDUCATION DR, MPMS ROOM 127, SCHENECTADY, NY 12303-1238
(518) 881-3413
(518) 881-3411
Mailing address
108 EDUCATION DR, MPMS ROOM 127, SCHENECTADY, NY 12303-1238
(518) 881-3413
(518) 881-3411
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
516385
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01406986
—
NY
Enumeration date
10/24/2011
Last updated
10/24/2011
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