Healthcare Provider Details

I. General information

NPI: 1295506319
Provider Name (Legal Business Name): SHANTELLE AESHA PIMENTEL HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107B COUNTY RD
NORTH FALMOUTH MA
02556-2019
US

IV. Provider business mailing address

1822 N MAIN ST STE 201
FALL RIVER MA
02720-1350
US

V. Phone/Fax

Practice location:
  • Phone: 508-548-8123
  • Fax: 508-548-2949
Mailing address:
  • Phone: 508-674-3334
  • Fax: 508-674-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHES6535
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: