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NPI Code Detail

MEDICARE: MRS. DOMINEAK SHANTA MILLER DOULA

MEDICARE: MRS. DOMINEAK SHANTA MILLER DOULA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1374J00000XDoulaIL

General Provider Information

NPI Number : 1215807797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DOMINEAK SHANTA MILLER DOULA
Provider Business Mailing Address
First Line : 212 S UNIVERSITY AVE
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-2925
Country : US
Telephone Number : 773-655-8103
Fax Number :
Provider Business Practice Location Address
First Line : 212 S UNIVERSITY AVE
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-2925
Country : US
Telephone Number : 773-655-8103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2025
Last Update Date : 04/23/2026

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Directions to “ MRS. DOMINEAK SHANTA MILLER DOULA” Practice Location

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