Provider Demographics
NPI:1235918160
Name:BEACHAM, SHANTEL C
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:C
Last Name:BEACHAM
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 1:9523 PERIDOT GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-6927
Mailing Address - Country:US
Mailing Address - Phone:586-335-5546
Mailing Address - Fax:
Practice Address - Street 1:9523 PERIDOT GREEN DR
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-6927
Practice Address - Country:US
Practice Address - Phone:586-335-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide