Provider Demographics
NPI:1821552068
Name:DANIELS, SHONTE' PATRICE
Entity Type:Individual
Prefix:
First Name:SHONTE'
Middle Name:PATRICE
Last Name:DANIELS
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 1:354 DEACON WAILES RD
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-4300
Mailing Address - Country:US
Mailing Address - Phone:713-247-9574
Mailing Address - Fax:
Practice Address - Street 1:107 FRONT ST STE 2134
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-2834
Practice Address - Country:US
Practice Address - Phone:318-336-2212
Practice Address - Fax:318-336-6067
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF08180268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily