Provider Demographics
NPI:1871539361
Name:SHANLEY, ANAMARIA GONZALEZ (APRN)
Entity type:Individual
Prefix:MRS
First Name:ANAMARIA
Middle Name:GONZALEZ
Last Name:SHANLEY
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3564 AVALON PARK EAST BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7365
Mailing Address - Country:US
Mailing Address - Phone:407-917-6015
Mailing Address - Fax:949-437-8401
Practice Address - Street 1:1954 HOWELL BRANCH RD STE 106
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1041
Practice Address - Country:US
Practice Address - Phone:407-917-6015
Practice Address - Fax:949-437-8401
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3252952363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ63390Medicare UPIN
FLU6923XMedicare PIN
FLU6923ZMedicare ID - Type UnspecifiedMEDICARE ID #