Provider Demographics
NPI:1194409250
Name:COLEMAN, SHUNTAE (AS,AA)
Entity type:Individual
Prefix:
First Name:SHUNTAE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:AS,AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10278 3RD ST N APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3908
Mailing Address - Country:US
Mailing Address - Phone:727-482-5253
Mailing Address - Fax:
Practice Address - Street 1:10278 3RD ST N APT B
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3908
Practice Address - Country:US
Practice Address - Phone:727-482-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator