Healthcare Provider Details

I. General information

NPI: 1831579853
Provider Name (Legal Business Name): SHANDA THOMAS SHRADER CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANDA SUZANNE THOMAS

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27550 STATE HIGHWAY 75
ONEONTA AL
35121-3203
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 205-625-5711
  • Fax:
Mailing address:
  • Phone: 352-627-9350
  • Fax: 352-273-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-134326
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number208000000X
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11025689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: