Provider Demographics
NPI:1669826145
Name:STELTER, SHAUNA (CMT)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:STELTER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 EVERGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-2104
Mailing Address - Country:US
Mailing Address - Phone:651-338-0488
Mailing Address - Fax:
Practice Address - Street 1:1018 EVERGREEN TRL
Practice Address - Street 2:
Practice Address - City:LINO LAKES
Practice Address - State:MN
Practice Address - Zip Code:55014-2104
Practice Address - Country:US
Practice Address - Phone:651-338-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist