Provider Demographics
NPI:1811272719
Name:BONMAN, SHAUNTELLE DENE (DO)
Entity type:Individual
Prefix:DR
First Name:SHAUNTELLE
Middle Name:DENE
Last Name:BONMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101C N GREENVILLE AVE # 616
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2235
Mailing Address - Country:US
Mailing Address - Phone:972-478-0696
Mailing Address - Fax:844-296-5471
Practice Address - Street 1:101C N GREENVILLE AVE # 616
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-2235
Practice Address - Country:US
Practice Address - Phone:972-478-0696
Practice Address - Fax:844-296-5471
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4191207Q00000X
CA20A11751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine