Provider Demographics
NPI:1346897394
Name:HAYES, SHANTELLE MARIE
Entity Type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:MARIE
Last Name:HAYES
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 1:250 GREGORY AVE
Mailing Address - Street 2:
Mailing Address - City:CHASE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23924-1840
Mailing Address - Country:US
Mailing Address - Phone:434-321-9474
Mailing Address - Fax:
Practice Address - Street 1:250 GREGORY AVE
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-1840
Practice Address - Country:US
Practice Address - Phone:434-321-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-23
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator