Provider Demographics
NPI:1477338473
Name:SANDERS, SHAWNA M
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 STILT LN
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-9468
Mailing Address - Country:US
Mailing Address - Phone:209-509-7551
Mailing Address - Fax:
Practice Address - Street 1:2858 STILT LN
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-9468
Practice Address - Country:US
Practice Address - Phone:209-509-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty