Provider Demographics
NPI:1841606720
Name:SHANTI MAMA WELLNESS
Entity Type:Organization
Organization Name:SHANTI MAMA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-808-9297
Mailing Address - Street 1:1 MILL ST
Mailing Address - Street 2:SUITE 244
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MILL ST
Practice Address - Street 2:SUITE 244
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1530
Practice Address - Country:US
Practice Address - Phone:978-808-9297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty