Provider Demographics
NPI:1073343034
Name:HILL, SHANTE
Entity type:Individual
Prefix:
First Name:SHANTE
Middle Name:
Last Name:HILL
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 1:603 ELIZABETH AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2423
Mailing Address - Country:US
Mailing Address - Phone:862-444-1477
Mailing Address - Fax:
Practice Address - Street 1:603 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2403
Practice Address - Country:US
Practice Address - Phone:862-444-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker