Provider Demographics
NPI:1154886729
Name:MONK, SHONTA M (LPN)
Entity type:Individual
Prefix:
First Name:SHONTA
Middle Name:M
Last Name:MONK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BOENAU ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-1201
Mailing Address - Country:US
Mailing Address - Phone:518-894-8731
Mailing Address - Fax:
Practice Address - Street 1:11 BOENAU ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1201
Practice Address - Country:US
Practice Address - Phone:518-894-8731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY816009163W00000X
NY278981164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse