Healthcare Provider Details

I. General information

NPI: 1396667739
Provider Name (Legal Business Name): SHANICE SHONDALEI STEPHENS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. SHANICE SHONDALEI REABROI

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3651 WHEELER RD
AUGUSTA GA
30909-6521
US

IV. Provider business mailing address

4868 TANNER OAKS DR
EVANS GA
30809-5130
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-8600
  • Fax:
Mailing address:
  • Phone: 706-504-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN284408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: