Provider Demographics
NPI:1538544176
Name:SCHALCH, SHANTEL MIRIAM BREE (COTA)
Entity type:Individual
Prefix:MISS
First Name:SHANTEL
Middle Name:MIRIAM BREE
Last Name:SCHALCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ZANG ST APT G3033
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1469
Mailing Address - Country:US
Mailing Address - Phone:520-256-8282
Mailing Address - Fax:
Practice Address - Street 1:106 SEEKRIGHT DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4571
Practice Address - Country:US
Practice Address - Phone:520-256-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-24
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist