Provider Demographics
NPI:1770678609
Name:SHANDLER, LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:SHANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LUISA STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-690-8436
Mailing Address - Fax:505-984-8967
Practice Address - Street 1:901 W ALAMEDA ST STE 25
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1673
Practice Address - Country:US
Practice Address - Phone:505-988-8869
Practice Address - Fax:505-982-6298
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM72227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMCS00007212OtherNM BOARD OF PHARMACY
NM25754Medicaid
NM72227OtherNM BOARD OF MEDICINE
C98095Medicare UPIN
NM25754Medicaid