Healthcare Provider Details

I. General information

NPI: 1982517967
Provider Name (Legal Business Name): SHANTEL NICOLE BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 BIRCH TRAIL CIR APT H
CHESAPEAKE VA
23320-8407
US

IV. Provider business mailing address

1708 BIRCH TRAIL CIR APT H
CHESAPEAKE VA
23320-8407
US

V. Phone/Fax

Practice location:
  • Phone: 757-803-1725
  • Fax:
Mailing address:
  • Phone: 757-803-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701016841
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: