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NPI Code Detail

MEDICARE: ANTON FEDOROVICH SHANIN FNP

MEDICARE: ANTON FEDOROVICH SHANIN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) Physician95031622CA
2363LF0000XFamily Nurse Practitioner95031622CA

General Provider Information

NPI Number : 1467283051
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTON FEDOROVICH SHANIN FNP
Provider Business Mailing Address
First Line : 17200 BURBANK BLVD APT 109
Second Line :
City : ENCINO
State : CA
Zip : 91316-1889
Country : US
Telephone Number : 310-924-0286
Fax Number :
Provider Business Practice Location Address
First Line : 4838 LAUREL CANYON BLVD
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91607-3717
Country : US
Telephone Number : 818-506-4455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2024
Last Update Date : 02/11/2026

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Directions to “ ANTON FEDOROVICH SHANIN FNP” Practice Location

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