Provider Demographics
NPI:1326800194
Name:ABU-AGEEL, SHANTELL D (LPN)
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:D
Last Name:ABU-AGEEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHANTELL
Other - Middle Name:D
Other - Last Name:CORDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4283 CLIFFORD RD
Mailing Address - Street 2:
Mailing Address - City:SILVERWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48760-9702
Mailing Address - Country:US
Mailing Address - Phone:248-622-7168
Mailing Address - Fax:
Practice Address - Street 1:4283 CLIFFORD RD
Practice Address - Street 2:
Practice Address - City:SILVERWOOD
Practice Address - State:MI
Practice Address - Zip Code:48760-9702
Practice Address - Country:US
Practice Address - Phone:248-622-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703106698164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse