Healthcare Provider Details

I. General information

NPI: 1538975552
Provider Name (Legal Business Name): SHANTAEL PILLSWORTH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANTAEL SWEENEY NP

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28062 BAXTER RD
MURRIETA CA
92563-1401
US

IV. Provider business mailing address

26741 CONTIGNAC DR
MURRIETA CA
92562-4501
US

V. Phone/Fax

Practice location:
  • Phone: 970-292-8687
  • Fax:
Mailing address:
  • Phone: 951-414-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number95033186
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95033186
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number95033186
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95033186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: