Provider Demographics
NPI:1942097654
Name:BURNETT, SHANITA MONET (SHARED LIVING PROVID)
Entity type:Individual
Prefix:
First Name:SHANITA
Middle Name:MONET
Last Name:BURNETT
Suffix:
Gender:F
Credentials:SHARED LIVING PROVID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-3304
Mailing Address - Country:US
Mailing Address - Phone:402-507-8110
Mailing Address - Fax:
Practice Address - Street 1:6719 N 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-3304
Practice Address - Country:US
Practice Address - Phone:402-507-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child