MEDICARE: MISS SHANTAYE T FELTON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	251S00000X	Community/Behavioral Health Agency
3	251E00000X	Home Health Agency	GA

General Provider Information

NPI Number	:	1528908407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHANTAYE T FELTON

Provider Business Mailing Address
First Line	:	1146 FELDMAN CHASE
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4849
Country	:	US
Telephone Number	:	856-419-1827
Fax Number	:

Provider Business Practice Location Address
First Line	:	1146 FELDMAN CHASE
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-4849
Country	:	US
Telephone Number	:	856-419-1827
Fax Number	:

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

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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