Provider Demographics
NPI:1154714624
Name:SHUTT, LAUREN HROBUCHAK (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:HROBUCHAK
Last Name:SHUTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ANNA
Other - Last Name:HROBUCHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 ALVERSER PLAZA
Mailing Address - Street 2:JAMES RIVER DERMATOLOGY
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-379-0116
Mailing Address - Fax:804-379-1088
Practice Address - Street 1:1316 ALVERSER PLAZA
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-379-0116
Practice Address - Fax:804-379-1088
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant