Provider Demographics
NPI:1235824988
Name:CONYER, SHONTA
Entity Type:Individual
Prefix:
First Name:SHONTA
Middle Name:
Last Name:CONYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 CEDAR ST SE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5002
Mailing Address - Country:US
Mailing Address - Phone:202-684-1391
Mailing Address - Fax:
Practice Address - Street 1:852 BARNABY ST SE APT 201
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3907
Practice Address - Country:US
Practice Address - Phone:202-450-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion