Provider Demographics
NPI:1871204826
Name:BURRELL, SHONTAYEL
Entity type:Individual
Prefix:
First Name:SHONTAYEL
Middle Name:
Last Name:BURRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:BELLWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60104-1109
Mailing Address - Country:US
Mailing Address - Phone:872-303-4938
Mailing Address - Fax:
Practice Address - Street 1:4400 SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:BELLWOOD
Practice Address - State:IL
Practice Address - Zip Code:60104-1109
Practice Address - Country:US
Practice Address - Phone:872-303-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health