Provider Demographics
NPI:1518314384
Name:SAUNDERS, SHAVON (LPN)
Entity Type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E HOFFMAN AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-5050
Mailing Address - Country:US
Mailing Address - Phone:631-965-9139
Mailing Address - Fax:
Practice Address - Street 1:5 E HOFFMAN AVE APT 6
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-5050
Practice Address - Country:US
Practice Address - Phone:631-965-9139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse