Healthcare Provider Details

I. General information

NPI: 1922984798
Provider Name (Legal Business Name): SHALONDA JONTA SANDERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E SHOTWELL ST
BAINBRIDGE GA
39819-4294
US

IV. Provider business mailing address

150 HILLCREST DR
BAINBRIDGE GA
39817-8368
US

V. Phone/Fax

Practice location:
  • Phone: 229-246-3500
  • Fax:
Mailing address:
  • Phone: 229-254-7720
  • Fax: 229-254-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN193546
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: