Healthcare Provider Details

I. General information

NPI: 1336051960
Provider Name (Legal Business Name): SHANTIEL MOREL BSHS, RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 7TH ST STE 100
ERIE PA
16502-1333
US

IV. Provider business mailing address

502 W 7TH ST STE 100
ERIE PA
16502-1333
US

V. Phone/Fax

Practice location:
  • Phone: 702-439-7240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH075436
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: