Provider Demographics
NPI:1518318393
Name:PARTNER, SHANDI LYN
Entity Type:Individual
Prefix:MRS
First Name:SHANDI
Middle Name:LYN
Last Name:PARTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHANDI
Other - Middle Name:LYN
Other - Last Name:PARTNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:4700 STONECROFT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1716
Mailing Address - Country:US
Mailing Address - Phone:571-585-7399
Mailing Address - Fax:703-488-6405
Practice Address - Street 1:4700 STONECROFT BLVD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1716
Practice Address - Country:US
Practice Address - Phone:571-585-7399
Practice Address - Fax:703-488-6405
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260016842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer