Provider Demographics
NPI:1639941875
Name:DEL VALLE, SHANTELLE NATASHA
Entity Type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:NATASHA
Last Name:DEL VALLE
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 1:133 AVE CAMPOBELLO
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1550
Mailing Address - Country:US
Mailing Address - Phone:787-960-1559
Mailing Address - Fax:
Practice Address - Street 1:133 AVE CAMPOBELLO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-1550
Practice Address - Country:US
Practice Address - Phone:787-960-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR154261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical