Provider Demographics
NPI:1043547094
Name:MONROSE, SHANEL YVONNE (MS)
Entity Type:Individual
Prefix:MISS
First Name:SHANEL
Middle Name:YVONNE
Last Name:MONROSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W 238TH ST
Mailing Address - Street 2:APT. 1C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4267
Mailing Address - Country:US
Mailing Address - Phone:347-534-8809
Mailing Address - Fax:
Practice Address - Street 1:116 W 238TH ST
Practice Address - Street 2:APT. 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4267
Practice Address - Country:US
Practice Address - Phone:347-534-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1139148174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator