Provider Demographics
NPI:1992049738
Name:TAITE, SHONTAL MONIQUE (LPN)
Entity type:Individual
Prefix:MS
First Name:SHONTAL
Middle Name:MONIQUE
Last Name:TAITE
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 1:4518 SCHIMPFS LN
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-1622
Mailing Address - Country:US
Mailing Address - Phone:251-661-0612
Mailing Address - Fax:251-661-0612
Practice Address - Street 1:4518 SCHIMPFS LN
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-1622
Practice Address - Country:US
Practice Address - Phone:251-661-0612
Practice Address - Fax:251-661-0612
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2060489164W00000X, 164X00000X
FLPN5204157164W00000X, 164X00000X
172A00000X, 372500000X, 372600000X, 374700000X, 3747A0650X, 3747P1801X, 374T00000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374700000XNursing Service Related ProvidersTechnician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide