Shantelle Daguilh, DNP
Individual provider Active NPI Nurse Practitioner · Edgewater, NJ
NPI 1386357689 · NPPES record last updated Feb 26, 2023
Key facts
- NPI
- 1386357689
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 350427 (NY)
- Practice address
- 473 River Rd Ste 114
Edgewater, NJ 07020-1145 - Phone
- (201) 679-0089
- NPI assigned
- Jan 2, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NJ01414300 | NJ | MD | Nurse Practitioner |
| 350427 | NY | MD | Nurse Practitioner |
| F350427 | NY | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 26NJ01414300 | NJ | |
| Nurse Practitioner | 363L00000X | F350427 | NY | |
| Nurse Practitioner | 363L00000X | 350427 | NY | Yes |
Addresses
Primary practice location
473 River Rd Ste 114
Edgewater, NJ 07020-1145
Mailing address
1204 85TH St
North Bergen, NJ 07047-4328
Phone (201) 679-0089
Other providers in Edgewater, NJ
- Jessica C Connelly
- Contemporary Womens Health Care LLC
- Maria A Coyle
- Cross County Cardiology P a
- Curalta Medical LLC
- Saurabh Dang
- Sameera Daud-Ahmad
- Debra Grossano Ms Rd Cde LLC
- Justin Delgado
- Carol Ann Boody Deutsch
All providers in Edgewater, NJ · Nurse Practitioner in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.