Active NPI
Jennifer Shattuck
- School Registered Nurse
- Schenectady, NY
National Provider Identifier
1386920304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Registered Nurse
- License
- 516385
- Practice address
- 108 Education Dr
MPMS Room 127
Schenectady, NY 12303-1238 - Phone
- (518) 881-3413
- Fax
- (518) 881-3411
- NPI assigned
- Oct 24, 2011
- Last updated
- Oct 24, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Registered Nurse | 163WS0200X | 516385 | NY | Primary |
Addresses
Primary practice location
108 Education Dr
MPMS Room 127
Schenectady, NY 12303-1238
Mailing address
108 Education Dr
MPMS Room 127
Schenectady, NY 12303-1238
Phone (518) 881-3413
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01406986 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 516385 | NY | MD | School Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Schenectady City School District | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Local Education Agency (LEA)
- Schenectady, NY
- NPI 1740557636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319414400000",
"number": "1386920304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 EDUCATION DR",
"address_2": "MPMS ROOM 127",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123031238",
"telephone_number": "518-881-3413",
"fax_number": "518-881-3411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "108 EDUCATION DR",
"address_2": "MPMS ROOM 127",
"city": "SCHENECTADY",
"state": "NY",
"postal_code": "123031238",
"telephone_number": "518-881-3413",
"fax_number": "518-881-3411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHATTUCK",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-24",
"last_updated": "2011-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "163WS0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, School",
"state": "NY",
"license": "516385",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01406986",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Schenectady, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.