Provider Demographics
NPI:1174137988
Name:LEE, MONTERRY SHATRAE
Entity type:Individual
Prefix:MRS
First Name:MONTERRY
Middle Name:SHATRAE
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 LOCK LN
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2543
Mailing Address - Country:US
Mailing Address - Phone:804-605-1566
Mailing Address - Fax:804-835-9678
Practice Address - Street 1:5 HOLLY HILL DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2559
Practice Address - Country:US
Practice Address - Phone:804-605-1566
Practice Address - Fax:804-835-9678
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12011103971744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management