Provider Demographics
NPI:1760657498
Name:DORFF, SHANDA RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANDA
Middle Name:RAE
Last Name:DORFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANDA
Other - Middle Name:RAE
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 270653
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0653
Mailing Address - Country:US
Mailing Address - Phone:651-756-9595
Mailing Address - Fax:651-340-8529
Practice Address - Street 1:4700 LEXINGTON AVE N STE C
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-5964
Practice Address - Country:US
Practice Address - Phone:651-756-9595
Practice Address - Fax:651-340-8529
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52481207Q00000X
WI70139-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine