MEDICARE: MS. SANDRA C. SHANAHAN C.R.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	R121329	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	641932-02	OTHER	MD	CAREFIRST MD RENDERING OD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7605-0067	OTHER	MD	CAREFIRST BLUECHOICE
4	107916	OTHER	MD	JHHC PROVIDER NUMBER

General Provider Information

NPI Number	:	1033101928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA C. SHANAHAN C.R.N.P.

Provider Business Mailing Address
First Line	:	1111 BENFIELD BLVD
Second Line	:	SUITE 200
City	:	MILLERSVILLE
State	:	MD
Zip	:	21108-3002
Country	:	US
Telephone Number	:	410-729-5100
Fax Number	:	410-729-5156

Provider Business Practice Location Address
First Line	:	7556 TEAGUE ROAD
Second Line	:	SUITE 210
City	:	HANOVER
State	:	MD
Zip	:	21076
Country	:	US
Telephone Number	:	410-551-0499
Fax Number	:	410-799-9070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/12/2009

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Directions to “ MS. SANDRA C. SHANAHAN C.R.N.P.” Practice Location

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