Provider Demographics
NPI:1215361035
Name:RAY, SHANTEL DOMINIQUE (RN)
Entity type:Individual
Prefix:
First Name:SHANTEL
Middle Name:DOMINIQUE
Last Name:RAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9323 BERKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4446
Mailing Address - Country:US
Mailing Address - Phone:423-314-9582
Mailing Address - Fax:
Practice Address - Street 1:9323 BERKSHIRE CIR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4446
Practice Address - Country:US
Practice Address - Phone:423-314-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN243630163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN243630OtherREGISTERED NURSE