Provider Demographics
NPI:1346327004
Name:ANDERSON, SHAWN D (BS)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:D
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-0454
Mailing Address - Country:US
Mailing Address - Phone:218-255-0655
Mailing Address - Fax:
Practice Address - Street 1:515 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1210
Practice Address - Country:US
Practice Address - Phone:218-366-9229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner