Provider Demographics
NPI:1477353225
Name:MARTINEZ Y CANTU, SHAWNTELL
Entity type:Individual
Prefix:
First Name:SHAWNTELL
Middle Name:
Last Name:MARTINEZ Y CANTU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MENAUL BLVD NW STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-1347
Mailing Address - Country:US
Mailing Address - Phone:505-252-8833
Mailing Address - Fax:
Practice Address - Street 1:2524 SARITA AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1980
Practice Address - Country:US
Practice Address - Phone:505-252-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician