Provider Demographics
NPI:1144797416
Name:SHONTA D COLLINS CONSULTING GROUP LLC
Entity Type:Organization
Organization Name:SHONTA D COLLINS CONSULTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHONTA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:215-219-9588
Mailing Address - Street 1:175 W COHAWKIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08020-1145
Mailing Address - Country:US
Mailing Address - Phone:856-423-7700
Mailing Address - Fax:856-423-0823
Practice Address - Street 1:28 THROCKMORTON LN STE 204
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2558
Practice Address - Country:US
Practice Address - Phone:732-952-3999
Practice Address - Fax:732-952-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty