Fuller, Shantel Azure

Fuller, Shantel Azure is an sole proprietor health care provider with primary practice located at 400 Ne 7Th St , Gresham OR 97030-5604. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Fuller, Shantel Azure can be contacted via phone (503) 661-5455.

Contact Information

Primary practice address
400 Ne 7Th St Gresham OR 97030-5604
Phone: (503) 661-5455
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1629240288
LBN Legal business name Fuller, Shantel Azure
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 24th, 2008
Last updated Mar 24th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Popular Providers