Provider Demographics
NPI:1205158771
Name:MAJOR, SHANTELL (ARNP)
Entity type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:MAJOR
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 1:3315 51ST ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-2155
Mailing Address - Country:US
Mailing Address - Phone:727-523-3891
Mailing Address - Fax:
Practice Address - Street 1:8001 9TH ST N # 574
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4109
Practice Address - Country:US
Practice Address - Phone:727-577-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9193045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002666700Medicaid
FLDJ391ZMedicare PIN