Provider Demographics
NPI:1730188525
Name:SHATNEY, PATRICIA A (FNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:SHATNEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CAMBRIDGE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4763
Mailing Address - Country:US
Mailing Address - Phone:203-335-0195
Mailing Address - Fax:203-335-7293
Practice Address - Street 1:7 CAMBRIDGE DR STE 201
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4763
Practice Address - Country:US
Practice Address - Phone:203-335-0195
Practice Address - Fax:203-335-7293
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001794363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004241064Medicaid
CT400001794CT02OtherANTHEM BC/BS
CT101794OtherCONNECTICARE
CT004241064Medicaid
CT400001794CT02OtherANTHEM BC/BS