MEDICARE: SHAVONDA GARDNER

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1891651972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVONDA GARDNER

Provider Business Mailing Address
First Line	:	4336 JOHNSTOWN LN
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3259
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4336 JOHNSTOWN LN
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3259
Country	:	US
Telephone Number	:	214-603-5861
Fax Number	:

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

Provider Enumeration Date	:	01/01/2026
Last Update Date	:	03/24/2026

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Directions to “ SHAVONDA GARDNER ” Practice Location

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