Healthcare Provider Details

I. General information

NPI: 1497159495
Provider Name (Legal Business Name): SHYLAH HALDEMAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161
US

IV. Provider business mailing address

1868 CATALINA BLVD
SAN DIEGO CA
92107-2641
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-3617
  • Fax:
Mailing address:
  • Phone: 856-430-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000766
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002511
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberLG0000766
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95062474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: