Provider Demographics
NPI:1043586761
Name:MONTAGUE, SHANTA (HHA)
Entity type:Individual
Prefix:
First Name:SHANTA
Middle Name:
Last Name:MONTAGUE
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 6TH ST SE
Mailing Address - Street 2:APT 5
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3883
Mailing Address - Country:US
Mailing Address - Phone:202-421-0925
Mailing Address - Fax:
Practice Address - Street 1:1707 L ST NW
Practice Address - Street 2:SUITE 900
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4201
Practice Address - Country:US
Practice Address - Phone:202-829-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide