Healthcare Provider Details

I. General information

NPI: 1508673146
Provider Name (Legal Business Name): SHAUNTRA LAMOTTE - OSBORNE BCHHP, CHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAUNTRA OSBORNE BCHHP, CHN

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 DELL RANGE BLVD SUITE 245 BOX# 3317
CHEYENNE WY
82009
US

IV. Provider business mailing address

2232 DELL RANGE BLVD SUITE 245 BOX# 3317
CHEYENNE WY
82009
US

V. Phone/Fax

Practice location:
  • Phone: 973-517-0182
  • Fax:
Mailing address:
  • Phone: 973-517-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number115535979
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number115535979
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: