1093754301 NPI number — MRS. JESSICA L SHEFFLER OTR

Table of content: AMY SINGH PHARMD (NPI 1508311432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093754301 NPI number — MRS. JESSICA L SHEFFLER OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEFFLER
Provider First Name:
JESSICA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILSON
Provider Other First Name:
JESSICA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093754301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 CALVARY HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATROBE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15650-9419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-787-3363
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6729 FIELDCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15626-7209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-216-5157
Provider Business Practice Location Address Fax Number:
724-325-1215
Provider Enumeration Date:
06/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  OC08113 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01863608 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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