Provider Demographics
NPI:1316651268
Name:TONG-ANTOLIN, SHUN DI SHIRLEY (FNP)
Entity type:Individual
Prefix:
First Name:SHUN DI
Middle Name:SHIRLEY
Last Name:TONG-ANTOLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:SHUN DI
Other - Last Name:TONG-ANTOLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1517 N SILVERVALE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-0027
Mailing Address - Country:US
Mailing Address - Phone:415-200-8956
Mailing Address - Fax:
Practice Address - Street 1:319 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5008
Practice Address - Country:US
Practice Address - Phone:855-733-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95023479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily