Healthcare Provider Details

I. General information

NPI: 1518572528
Provider Name (Legal Business Name): SHAUNA SANDERSON ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK AVE S STE 16389
NEW YORK NY
10003-0103
US

IV. Provider business mailing address

169 MADISON AVE STE 38114
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 646-876-8455
  • Fax:
Mailing address:
  • Phone: 646-876-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberTPAN3763
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP034971
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2020014482
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024196686
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0038521
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberC-APN.0105527-C-NP
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433742
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1229699
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberGAA-NP005421
License Number StateGA
# 10
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number30739
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: