Provider Demographics
NPI:1770149288
Name:OLIVER, SHONTESE
Entity type:Individual
Prefix:
First Name:SHONTESE
Middle Name:
Last Name:OLIVER
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 1:5616 SAINT BARNABAS RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3626
Mailing Address - Country:US
Mailing Address - Phone:301-338-4901
Mailing Address - Fax:
Practice Address - Street 1:929 SLOAN AVE
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2871
Practice Address - Country:US
Practice Address - Phone:301-728-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management