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General NPI Number Information
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NPI Number | 1831251636
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Entity Type | Individual
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Provider Name | SANDRA JEAN SHELMERDINE MD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 300 W HOSPITAL RD EISENHOWER ARMY MEDICAL CENTER ATTN CREDENTIAL
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City | AUGUSTA
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-2720
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Fax | 706-787-8176
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Provider Business Mailing Address
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Address Line | 3551 ROGER BROOKE DR
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City | JBSA FT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone |
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101234141
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License Number State | VA
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