Individual
SHANTANAI LARESA SEALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
370 MEMORIAL PKWY STE 3, PHILLIPSBURG, NJ 08865-1580
(908) 689-1000
Mailing address
67 HALSTEAD ST APT 1104, CLINTON, NJ 08809-1419
(732) 372-5804
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06331900
NJ
Other
Enumeration date
04/30/2020
Last updated
04/30/2020
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