Individual
SHANTISE PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2040 MILLBURN AVE STE 305, MAPLEWOOD, NJ 07040-3716
(973) 901-3640
Mailing address
1128 N STILES ST # A, LINDEN, NJ 07036-6122
(973) 901-3640
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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