Provider Demographics
NPI:1306410964
Name:MORGAN, SHANELL LARAI (STNA)
Entity type:Individual
Prefix:
First Name:SHANELL
Middle Name:LARAI
Last Name:MORGAN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BOUQUET AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2902
Mailing Address - Country:US
Mailing Address - Phone:330-770-5221
Mailing Address - Fax:
Practice Address - Street 1:217 BOUQUET AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2902
Practice Address - Country:US
Practice Address - Phone:330-953-8772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400418891004376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide