Individual
MISS AMANDA JANE SHANKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAP, PA-C
Contact information
Practice address
22431 ANTONIO PKWY # B160-613, RANCHO SANTA MARGARITA, CA 92688-2804
(833) 477-2677
(833) 477-2677
Mailing address
22431 ANTONIO PKWY # B160-613, RANCHO SANTA MARGARITA, CA 92688-2804
(833) 477-2677
(833) 477-2677
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20694
CA
363AS0400X
Surgical Physician Assistant
PA20964
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA20964
CA LICENSE
CA
Enumeration date
03/14/2010
Last updated
06/21/2024
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