Provider Demographics
NPI:1164251179
Name:STOVALL, SHANELLE L
Entity type:Individual
Prefix:
First Name:SHANELLE
Middle Name:L
Last Name:STOVALL
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 1:183 CAREY DR # 183-02
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19383-2012
Mailing Address - Country:US
Mailing Address - Phone:856-333-2807
Mailing Address - Fax:
Practice Address - Street 1:183 CAREY DR # 183-02
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19383-1318
Practice Address - Country:US
Practice Address - Phone:856-341-6417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program