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General NPI Number Information
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NPI Number | 1801602495
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Entity Type | Individual
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Provider Name | SHANTANECE HARMON
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Gender | Female
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | PO BOX 2164
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City | GLEN BURNIE
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State | MD
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Zip | 21060-2164
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Country | US
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Telephone | 667-305-5312
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2164
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City | GLEN BURNIE
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State | MD
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Zip | 21060-2164
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Country | US
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Telephone | 667-305-5312
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | SXOYKTFQGH
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State | MD
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