Individual
ASHLEY ROSE SHUTACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
4 BREE DR, HAMILTON SQUARE, NJ 08690-1502
(609) 529-3454
Mailing address
4 BREE DR, HAMILTON SQUARE, NJ 08690-1502
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NJX3HZN34669260
HORIZON BLUE CROSS BLUE SHIELD
NJ
Enumeration date
11/26/2018
Last updated
10/02/2020
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