Healthcare Provider Details

I. General information

NPI: 1356214530
Provider Name (Legal Business Name): SHANTELE MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 CEDAR AVE APT K
LONG BEACH CA
90806-2950
US

IV. Provider business mailing address

2475 CEDAR AVE APT K
LONG BEACH CA
90806-2950
US

V. Phone/Fax

Practice location:
  • Phone: 562-805-7798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number94319
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: