Provider Demographics
NPI:1457108508
Name:ANTHONY, SHAMHAAN
Entity Type:Individual
Prefix:
First Name:SHAMHAAN
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 469 BOX 1253
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09227-0013
Mailing Address - Country:US
Mailing Address - Phone:314-590-2603
Mailing Address - Fax:
Practice Address - Street 1:FIRST STREET BUILDING 3701
Practice Address - Street 2:
Practice Address - City:LANDSTUHL
Practice Address - State:RHEINLAND PFALZ
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:314-590-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist