Provider Demographics
NPI:1760876122
Name:SANDIFER, SHANA (APRN)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MEYERS BAKER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3039
Mailing Address - Country:US
Mailing Address - Phone:606-878-3240
Mailing Address - Fax:606-878-3245
Practice Address - Street 1:803 MEYERS BAKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3039
Practice Address - Country:US
Practice Address - Phone:606-878-3240
Practice Address - Fax:606-878-3245
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3009288363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner