Provider Demographics
NPI:1366473142
Name:CANTONI, SHANA B (ARNP)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:B
Last Name:CANTONI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SUMMIT AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5619
Mailing Address - Country:US
Mailing Address - Phone:206-818-8263
Mailing Address - Fax:845-302-8822
Practice Address - Street 1:226 SUMMIT AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5619
Practice Address - Country:US
Practice Address - Phone:206-818-8263
Practice Address - Fax:845-302-8827
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006360363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638495Medicaid
WA0168701OtherL&I PIN
WA63993UOtherREGENCE BLUE SHIELD PIN
WA63993UOtherREGENCE BLUE SHIELD PIN
P98488Medicare UPIN