Individual
SHANTANA MYLEKA RAE BENALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
703 NE HANCOCK ST, PORTLAND, OR 97212-3955
(971) 217-9008
(971) 260-0355
Mailing address
211 SE CARUTHERS ST, PORTLAND, OR 97214-4502
(971) 217-9008
(971) 260-0355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
10055531
OR
163W00000X
Registered Nurse
9871186
ID
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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