Healthcare Provider Details

I. General information

NPI: 1730904293
Provider Name (Legal Business Name): SHEADRIAN ANTALAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 SCHILLINGER RD N STE 102
MOBILE AL
36608-5060
US

IV. Provider business mailing address

30 SCHILLINGER RD N STE 102
MOBILE AL
36608-5060
US

V. Phone/Fax

Practice location:
  • Phone: 251-202-9168
  • Fax:
Mailing address:
  • Phone: 251-202-9168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1167734
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: