Provider Demographics
NPI:1801607924
Name:SAM, SHANTEL MELISSA-SOTO (CLC)
Entity type:Individual
Prefix:MRS
First Name:SHANTEL
Middle Name:MELISSA-SOTO
Last Name:SAM
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 MARTHA LEE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3789
Mailing Address - Country:US
Mailing Address - Phone:787-543-2438
Mailing Address - Fax:
Practice Address - Street 1:232 MARTHA LEE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3789
Practice Address - Country:US
Practice Address - Phone:787-543-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
350020174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN