Provider Demographics
NPI:1124538830
Name:EASTHAM, SHANDALYN ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHANDALYN
Middle Name:ANN
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PRESTON RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5189
Mailing Address - Country:US
Mailing Address - Phone:972-632-2358
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESTON RD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5189
Practice Address - Country:US
Practice Address - Phone:214-519-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-08
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135269363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily