Provider Demographics
NPI:1942068325
Name:FONTAINE, SHAWNDELLANA DEWON
Entity Type:Individual
Prefix:
First Name:SHAWNDELLANA
Middle Name:DEWON
Last Name:FONTAINE
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 1:3312 CURTIS DR APT 301
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2653
Mailing Address - Country:US
Mailing Address - Phone:202-609-3816
Mailing Address - Fax:
Practice Address - Street 1:3312 CURTIS DR APT 301
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2653
Practice Address - Country:US
Practice Address - Phone:202-609-3816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT0067063374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician