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Individual
SHANA THEOBALD
Active
Individual
SHANA THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
160381
FL
207Q00000X
Family Medicine Physician
Primary
19456
HI
207Q00000X
Family Medicine Physician
204827
CA
207Q00000X
Family Medicine Physician
25MA11580200
NJ
207Q00000X
Family Medicine Physician
75194
TN
207Q00000X
Family Medicine Physician
7901
AK
207R00000X
Internal Medicine Physician
51568
CO
Other
Enumeration date
06/16/2010
Last updated
04/23/2026
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