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General NPI Number Information
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NPI Number | 1477381598
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Entity Type | Individual
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Provider Name | SHANNA TANNER SCLATER
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Gender | Female
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Dates
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Enumeration Date | 07/22/2024
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 5321 RIVER PLANTATION DR
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City | THEODORE
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State | AL
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Zip | 36582-7562
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Country | US
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Telephone | 251-366-9046
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Fax |
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Provider Business Mailing Address
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Address Line | 5321 RIVER PLANTATION DR
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City | THEODORE
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State | AL
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Zip | 36582-7562
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Country | US
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Telephone | 251-366-9046
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2689
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License Number State | AL
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