Provider Demographics
NPI:1578292280
Name:SANDERS, SHAWN PATRICK
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:PATRICK
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3797 GREASY CRK
Mailing Address - Street 2:
Mailing Address - City:SHELBIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41562-8507
Mailing Address - Country:US
Mailing Address - Phone:606-213-0166
Mailing Address - Fax:
Practice Address - Street 1:3793 GREASY CRK RD
Practice Address - Street 2:
Practice Address - City:SHELBIANA
Practice Address - State:KY
Practice Address - Zip Code:41562
Practice Address - Country:US
Practice Address - Phone:606-213-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist