Provider Demographics
NPI:1578275632
Name:CHALK, SHAUNTEEL L (CNM)
Entity Type:Individual
Prefix:
First Name:SHAUNTEEL
Middle Name:L
Last Name:CHALK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ ST STE 1490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6946
Mailing Address - Country:US
Mailing Address - Phone:713-512-7700
Mailing Address - Fax:240-696-1353
Practice Address - Street 1:4000 GARTH RD STE 200
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3169
Practice Address - Country:US
Practice Address - Phone:281-886-7566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX941010163W00000X
TX1102085367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1102085OtherTEXAS BOARD OF NURSING
TX941010OtherTEXAS BOARD OF NURSING