Individual
TONYA D SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2731 MLK JR BLVD, TUSCALOOSA, AL 35401-5235
(205) 349-3250
(205) 345-3993
Mailing address
PO BOX 2400, TUSCALOOSA, AL 35403-2400
(205) 614-6102
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1082093
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104109
—
AL
01
—
515-93760
BCBS/AL
AL
Enumeration date
08/17/2007
Last updated
10/27/2014
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