Healthcare Provider Details

I. General information

NPI: 1609695360
Provider Name (Legal Business Name): SHANDAY ALLEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 3RD ST
MACON GA
31201-3294
US

IV. Provider business mailing address

610 3RD ST
MACON GA
31201-3294
US

V. Phone/Fax

Practice location:
  • Phone: 478-464-2600
  • Fax: 478-238-8501
Mailing address:
  • Phone: 478-464-2600
  • Fax: 478-238-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN296754
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: