Provider Demographics
NPI:1932765021
Name:HARVEY, SHAUNTELE L
Entity Type:Individual
Prefix:
First Name:SHAUNTELE
Middle Name:L
Last Name:HARVEY
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 1:13740 MIDWAY RD STE 524
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4480
Mailing Address - Country:US
Mailing Address - Phone:972-286-3537
Mailing Address - Fax:
Practice Address - Street 1:13740 MIDWAY RD STE 524
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-4480
Practice Address - Country:US
Practice Address - Phone:972-286-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043714678OtherNPI