Provider Demographics
NPI:1215593041
Name:ANTON, SHANA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:ELIZABETH
Last Name:ANTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:ELIZABETH
Other - Last Name:SANDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6801 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-6844
Mailing Address - Country:US
Mailing Address - Phone:727-822-3238
Mailing Address - Fax:727-823-1278
Practice Address - Street 1:6801 4TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6844
Practice Address - Country:US
Practice Address - Phone:727-822-3238
Practice Address - Fax:727-823-1278
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME155616207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program