Provider Demographics
NPI:1245967413
Name:SHAVERS, SANDRA R (NP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WALL ST APT 2J
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4521
Mailing Address - Country:US
Mailing Address - Phone:334-549-0554
Mailing Address - Fax:
Practice Address - Street 1:1303 DR MARTIN L KING JR AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5341
Practice Address - Country:US
Practice Address - Phone:251-432-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-096584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine