Provider Demographics
NPI:1114770229
Name:VALENTINE, SHANTAU A
Entity type:Individual
Prefix:
First Name:SHANTAU
Middle Name:A
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N DAVIS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3200
Mailing Address - Country:US
Mailing Address - Phone:945-954-0574
Mailing Address - Fax:972-957-5215
Practice Address - Street 1:910 N DAVIS DR STE 100
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3200
Practice Address - Country:US
Practice Address - Phone:945-954-0574
Practice Address - Fax:972-295-7521
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1052371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner