Healthcare Provider Details

I. General information

NPI: 1811824543
Provider Name (Legal Business Name): SHONTEL THOMAS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N OLDEN AVENUE EXT STE 29
EWING NJ
08618-2111
US

IV. Provider business mailing address

1608 RAVENS CREST DR
PLAINSBORO NJ
08536-2466
US

V. Phone/Fax

Practice location:
  • Phone: 609-237-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05241500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: