SHANITTA ANTALLESHIA RANDOLPH (NPI# 1699372359) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699372359 |
| Entity Type | Individual |
| Full Name | SHANITTA ANTALLESHIA RANDOLPH |
| Practice Address |
1709 Bragaw St Anchorage AK 99508-3436 |
| Mailing Address |
6800 E 12th Ave Anchorage AK 99504-1832 |
| Practice Telephone | 9073462101 |
| Mailing Telephone | 9073100769 |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| Street Address |
1709 BRAGAW ST |
| City | ANCHORAGE |
| State | AK |
| Zip Code | 99508-3436 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033263439 | Michael D Robertson | Psychiatry & Neurology | 1709 Bragaw St, Suite A, Anchorage, AK 99508-3436 | 2007-01-22 |
| 1780284984 | Juita Iamayia Johnson | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-27 |
| 1942809561 | Brittany Irby | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-23 |
| 1932707163 | Helen Eve Griese-bravo | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-09 |
| 1215534581 | Samantha Gray | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-08 |
| 1053918631 | Juita Johnson | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-06 |
| 1861099657 | Diane Murray | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-05 |
| 1548867674 | Leola Luciel Flowers X | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-10-01 |
| 1629685888 | Evelyn Castillo Kelleher | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-09-30 |
| 1164039962 | Michelle Laws | Counselor | 1709 Bragaw St, Anchorage, AK 99508-3436 | 2020-09-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366063349 | Alexandra L Davis | Student in an Organized Health Care Education/Training Program | 1202 E 36th Ave, Anchorage, AK 99508 | 2020-05-01 |
| 1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
| 1679120349 | Kila Gilcart | Speech-Language Pathologist | 161 Klevin Street #103, Anchorage, AK 99508 | 2019-08-19 |
| 1326692963 | Shannon Maillet | Behavior Technician | 1650 S Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1427602044 | Frank Harris Lawson Iv | Behavior Technician | 1650 S. Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1104470723 | Vivalesi Seforosa Nair | Behavior Technician | 1650 South Bragaw, Anchorage, AK 99508 | 2019-07-31 |
| 1043864267 | The Cozy Chalet Assisted Living Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3707 Mt Blanc Circle, Anchorage, AK 99508 | 2019-07-25 |
| 1942861778 | Christine Mary Hoover | Registered Nurse | Alaska Native Medical Center - Inpatient Pediatrics, 4315 Diplomacy Dr, Anchorage, AK 99508 | 2019-06-24 |
| 1215594502 | Ashley Ongtowasruk | Case Manager/Care Coordinator | 4441 Dipomacy Dr, Suite 500, Anchorage, AK 99508 | 2019-05-22 |
| 1659937019 | Rayne Johnson | Behavior Technician | 4000 San Ernesto Blvd, Anchorage, AK 99508 | 2019-05-11 |
| Find all providers in zip 99508 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033710157 | Ida Brothers | Counselor | 2705 W 67th Ave, Anchorage, AK 99502-2222 | 2020-11-04 |
| 1831799287 | Martina A Diamond | Counselor | 3616 Peterkin Ave, Anchorage, AK 99508-1131 | 2020-10-27 |
| 1598362972 | Annette F Wilson | Counselor | 5674 Alora Loop, Anchorage, AK 99504-1050 | 2020-10-08 |
| 1386241917 | Jerome Donald Velcheff | Counselor | 719 Edward St # B, Anchorage, AK 99504-1664 | 2020-10-06 |
| 1386241313 | Lori Ann Velcheff | Counselor | 6800 Howard Ave, Anchorage, AK 99504-1870 | 2020-10-02 |
| 1063019107 | Katherine Patricia Jerue | Counselor | 632 W 15th Ave, Anchorage, AK 99501-5006 | 2020-10-01 |
| 1518584267 | Janna Harvey | Counselor | 2804 W Northern Lights Blvd Ste 280, Anchorage, AK 99517-3300 | 2020-06-29 |
| 1013547306 | Samuel Peterson | Counselor | 4600 Debarr Rd, Anchorage, AK 99508-3103 | 2020-01-25 |
| 1750911335 | Brandi Lyn Ropati-hunte | Counselor | 3406 Seppala Dr Unit B3406, Anchorage, AK 99517-1143 | 2020-01-22 |
| 1538704986 | Ashley Locke | Counselor | 880 H St Ste 201, Anchorage, AK 99501-3450 | 2019-11-08 |
| Find all providers in ANCHORAGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.