Provider Demographics
NPI:1407669567
Name:TEEL, SHANTIYA LATOYA NACHELL (RN-NP STUDENT)
Entity type:Individual
Prefix:
First Name:SHANTIYA
Middle Name:LATOYA NACHELL
Last Name:TEEL
Suffix:
Gender:F
Credentials:RN-NP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6749 POPLAR GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6330
Mailing Address - Country:US
Mailing Address - Phone:470-375-2103
Mailing Address - Fax:
Practice Address - Street 1:6749 POPLAR GROVE WAY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6330
Practice Address - Country:US
Practice Address - Phone:470-375-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280096163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program