Provider Demographics
NPI:1396415485
Name:DOFFONEY, SHANTEL MONIQUE (LVN)
Entity Type:Individual
Prefix:
First Name:SHANTEL
Middle Name:MONIQUE
Last Name:DOFFONEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2398 MONICA ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4512
Mailing Address - Country:US
Mailing Address - Phone:832-231-0241
Mailing Address - Fax:
Practice Address - Street 1:3027 MARINA BAY DR STE 344
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3089
Practice Address - Country:US
Practice Address - Phone:281-968-2745
Practice Address - Fax:281-968-2747
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311662164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty