Provider Demographics
NPI:1043755861
Name:MONTANTE, SHELLY (NP)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:MONTANTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7625
Mailing Address - Country:US
Mailing Address - Phone:804-928-6632
Mailing Address - Fax:
Practice Address - Street 1:5706 GROVE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2346
Practice Address - Country:US
Practice Address - Phone:804-325-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174983363L00000X
VA0017144062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner