Organization
SHANTISE MICHELLE LLC
Active
Other names
Shantise Michelle Cranial Prosthesis
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHANTISE PARKER (OWNER)
(973) 901-3640
Entity
Organization
Contact information
Practice address
2040 MILLBURN AVE STE 305, MAPLEWOOD, NJ 07040-3716
(973) 901-3640
Mailing address
2040 MILLBURN AVE STE 305, MAPLEWOOD, NJ 07040-3716
(973) 901-3640
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
08/06/2020
Last updated
02/09/2024
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