Individual
SHANNON KATHLEEN ANASTASIADIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5415 NE 38TH AVE, PORTLAND, OR 97211-8009
(503) 735-5230
Mailing address
5415 NE 38TH AVE, PORTLAND, OR 97211-8009
(503) 735-5230
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
200150083NP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202114832NP
OR
Other
Enumeration date
01/19/2007
Last updated
02/09/2022
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