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General NPI Number Information
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NPI Number | 1467283051
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Entity Type | Individual
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Provider Name | ANTON FEDOROVICH SHANIN FNP
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Gender | Male
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 4838 LAUREL CANYON BLVD
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91607-3717
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Country | US
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Telephone | 818-506-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 12302 DOWNEY AVE
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City | DOWNEY
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State | CA
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Zip | 90242-3514
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Country | US
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Telephone | 310-924-0286
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95031622
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 95031622
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License Number State | CA
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