Provider Demographics
NPI:1265265862
Name:FOOTE, SHANTELLE DAMARIS
Entity type:Individual
Prefix:MRS
First Name:SHANTELLE
Middle Name:DAMARIS
Last Name:FOOTE
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 1:4988 WOODPECKER RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-6992
Mailing Address - Country:US
Mailing Address - Phone:302-548-9602
Mailing Address - Fax:
Practice Address - Street 1:4988 WOODPECKER RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-6992
Practice Address - Country:US
Practice Address - Phone:302-548-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula