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General NPI Number Information
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NPI Number | 1730284076
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Entity Type | Individual
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Provider Name | SANDRA D. SHANABERGER P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 1009A N DUPONT SQ
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City | LOUISVILLE
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State | KY
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Zip | 40207-4612
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Country | US
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Telephone | 502-894-9950
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Fax |
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Provider Business Mailing Address
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Address Line | 4011 LELAND RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-2007
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Country | US
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Telephone | 859-699-9946
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Fax | 502-894-9991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA432
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License Number State | KY
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