MEDICARE: SHANDA L J MORRIS MD, PLLC

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	363L00000X	Nurse Practitioner
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000051565	OTHER	KY	ANTHEM-SM
2	000000311801	OTHER	KY	ANTHEM-MA

General Provider Information

NPI Number	:	1275665143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANDA L J MORRIS MD, PLLC

Provider Business Mailing Address
First Line	:	1120 MCCANN DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1157
Country	:	US
Telephone Number	:	859-744-0032
Fax Number	:	859-744-0154

Provider Business Practice Location Address
First Line	:	1120 MCCANN DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1157
Country	:	US
Telephone Number	:	859-744-0032
Fax Number	:	859-744-0154

Authorized Official
Title or Position	:	OWNER
Name	:	SHANDA L MORRIS
Credential	:	MD
Telephone Number	:	859-744-0032

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	09/28/2012

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