Healthcare Provider Details

I. General information

NPI: 1043755861
Provider Name (Legal Business Name): SHELLY MONTANTE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5706 GROVE AVE STE 201
RICHMOND VA
23226-2346
US

IV. Provider business mailing address

7605 FOREST AVE STE 100
HENRICO VA
23229-7625
US

V. Phone/Fax

Practice location:
  • Phone: 804-325-4795
  • Fax:
Mailing address:
  • Phone: 804-928-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024174983
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0017144062
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: