Healthcare Provider Details

I. General information

NPI: 1154886729
Provider Name (Legal Business Name): SHONTA M MONK LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHONTA MONK-BURT

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BOENAU ST
ALBANY NY
12202-1201
US

IV. Provider business mailing address

11 BOENAU ST
ALBANY NY
12202-1201
US

V. Phone/Fax

Practice location:
  • Phone: 518-894-8731
  • Fax:
Mailing address:
  • Phone: 518-894-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number278981
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408675
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number816009
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: