Healthcare Provider Details

I. General information

NPI: 1407257793
Provider Name (Legal Business Name): SHAUN MARK SAUNDERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 2 BOX 60
APO AE
09094-9001
US

IV. Provider business mailing address

OPC 2 BOX 60
APO AE
09094-9001
US

V. Phone/Fax

Practice location:
  • Phone: 314-480-4758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15920
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: