Individual
SANDRA D. SHANABERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1009A N DUPONT SQ, LOUISVILLE, KY 40207-4612
(502) 894-9950
Mailing address
4011 LELAND RD, LOUISVILLE, KY 40207-2007
(859) 699-9946
(502) 894-9991
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA432
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
95001640
—
KY
01
—
970021516
RR MEDICARE PIN
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
09/13/2006
Last updated
02/06/2020
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