Provider Demographics
NPI:1174200570
Name:GONTINA, SHAUNDRA
Entity type:Individual
Prefix:
First Name:SHAUNDRA
Middle Name:
Last Name:GONTINA
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 1:236 MURIEL ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-6153
Mailing Address - Country:US
Mailing Address - Phone:409-454-1138
Mailing Address - Fax:
Practice Address - Street 1:236 MURIEL ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-6153
Practice Address - Country:US
Practice Address - Phone:409-454-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty