Provider Demographics
NPI:1275665143
Name:SHANDA L J MORRIS MD, PLLC
Entity Type:Organization
Organization Name:SHANDA L J MORRIS MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-744-0032
Mailing Address - Street 1:1120 MCCANN DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1157
Mailing Address - Country:US
Mailing Address - Phone:859-744-0032
Mailing Address - Fax:859-744-0154
Practice Address - Street 1:1120 MCCANN DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1157
Practice Address - Country:US
Practice Address - Phone:859-744-0032
Practice Address - Fax:859-744-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000051565OtherANTHEM-SM
KY000000311801OtherANTHEM-MA
KY000000051565OtherANTHEM-SM
KYK022821Medicare PIN