Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R121329 | MD |
NPI | 1033101928 |
---|---|
Provider Name | Ms. Sandra C. Shanahan |
First Address | Millersville, MD 21108-3002 |
Second Address | Hanover, MD 21076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 12/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107916 | JHHC PROVIDER NUMBER (01) | MD |
405743100 | (05) | MD |
641932-02 | CAREFIRST MD RENDERING OD (01) | MD |
7605-0067 | CAREFIRST BLUECHOICE (01) | MD |
Q20010 | (02) |