Provider Demographics
NPI:1467604751
Name:BIRDSALL, SHAUNA MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:MARIE
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:REY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:8505 SKYHILLS DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-3993
Mailing Address - Country:US
Mailing Address - Phone:847-774-8414
Mailing Address - Fax:
Practice Address - Street 1:915 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2408
Practice Address - Country:US
Practice Address - Phone:907-770-6700
Practice Address - Fax:079-770-6707
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001350175F00000X
AZ08-1092175F00000X
CAND1055175F00000X
AK151349175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath