Provider Demographics
NPI:1962747048
Name:MASTRANGELO, SHANNA MAE NAOMI (FNP-C, CPM)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:MAE NAOMI
Last Name:MASTRANGELO
Suffix:
Gender:F
Credentials:FNP-C, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 ARDEN NOLLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-6113
Mailing Address - Country:US
Mailing Address - Phone:301-991-7414
Mailing Address - Fax:
Practice Address - Street 1:5187 ARDEN NOLLVILLE RD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6113
Practice Address - Country:US
Practice Address - Phone:301-991-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MDAC006009363LF0000X
WV105987363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife