Provider Demographics
NPI:1275578940
Name:SHUFFETT, SANDRA ROBBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ROBBIN
Last Name:SHUFFETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1471
Practice Address - Country:US
Practice Address - Phone:859-260-6537
Practice Address - Fax:859-260-4151
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0453942085R0202X
KY437712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100146460Medicaid
KY7100146460Medicaid
KYP400035312Medicare PIN