Provider Demographics
NPI:1841833035
Name:JOSEPH, SHANTY SAJIMON (FNP)
Entity type:Individual
Prefix:MRS
First Name:SHANTY
Middle Name:SAJIMON
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6326 KINGSTON RNCH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4873
Mailing Address - Country:US
Mailing Address - Phone:210-996-1111
Mailing Address - Fax:
Practice Address - Street 1:6326 KINGSTON RNCH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4873
Practice Address - Country:US
Practice Address - Phone:210-996-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily