| Doctor Name: | JENNIFER ANNE SHATTUCK |
| NPI Number: | 1023032729 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 334772 |
| Business Practice Address: | 260 Riverside Dr Johnson City, NY - 137902745 |
| Business Phone Number: | 6077987811 |
| Business Fax Number: | |
| Mailing Address: | 260 Riverside Dr, JOHNSON CITY |
| State: | NY |
| Postal Code: | 137902745 |
| Phone Number: | 6077987811 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 334772 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |