Provider Demographics
NPI:1467171041
Name:LEONE, SHANTAE L
Entity Type:Individual
Prefix:
First Name:SHANTAE
Middle Name:L
Last Name:LEONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANTAE
Other - Middle Name:L
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4301 FORBES DR
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-9701
Mailing Address - Country:US
Mailing Address - Phone:410-322-4437
Mailing Address - Fax:
Practice Address - Street 1:4301 FORBES DR
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-9701
Practice Address - Country:US
Practice Address - Phone:410-322-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28018104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty