Provider Demographics
NPI:1346900990
Name:PITTMAN, SHANTE R
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:R
Last Name:PITTMAN
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:PO BOX 56091
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-6091
Mailing Address - Country:US
Mailing Address - Phone:501-680-2223
Mailing Address - Fax:501-500-5732
Practice Address - Street 1:8509 W MARKHAM ST # 56091
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2432
Practice Address - Country:US
Practice Address - Phone:501-680-2223
Practice Address - Fax:501-500-5732
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy