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Individual
SHANA S. STANDARD
Active
Individual
SHANA S. STANDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003540
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01270783
AMERIGROUP
—
05
—
100000855C
—
GA
01
—
P00610133
RR MEDICARE
GA
Enumeration date
07/20/2006
Last updated
10/23/2024
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