MEDICARE: SHONTEL SHEREE AUSTIN CNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1073377768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTEL SHEREE AUSTIN CNA

Provider Business Mailing Address
First Line	:	1539 REDMAN BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-2547
Country	:	US
Telephone Number	:	618-419-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 REDMAN BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-2547
Country	:	US
Telephone Number	:	618-419-3883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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Directions to “ SHONTEL SHEREE AUSTIN CNA” Practice Location

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