Provider Demographics
NPI:1093859043
Name:NELSON, SHAWNTANA ORLANDO
Entity Type:Individual
Prefix:MR
First Name:SHAWNTANA
Middle Name:ORLANDO
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7676 JACKSON DR
Mailing Address - Street 2:SUITE# 7
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1500
Mailing Address - Country:US
Mailing Address - Phone:619-339-4148
Mailing Address - Fax:619-591-9373
Practice Address - Street 1:7676 JACKSON DR
Practice Address - Street 2:SUITE# 7
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1500
Practice Address - Country:US
Practice Address - Phone:619-339-4148
Practice Address - Fax:619-591-9373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies