Provider Demographics
NPI:1174906044
Name:PETTINI, SHAYNA M (AUD)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:M
Last Name:PETTINI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:M
Other - Last Name:GOODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6379
Mailing Address - Country:US
Mailing Address - Phone:304-243-3000
Mailing Address - Fax:304-243-3060
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6379
Practice Address - Country:US
Practice Address - Phone:304-243-3000
Practice Address - Fax:304-243-3060
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01974231H00000X
WVA-0322231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist