Provider Demographics
NPI:1265050496
Name:SANDERS, SHEMAIAH LAMAR (RN)
Entity type:Individual
Prefix:MR
First Name:SHEMAIAH
Middle Name:LAMAR
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:SHEMAIAH
Other - Middle Name:LAMAR
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1918 1ST AVE APT 804
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-7480
Mailing Address - Country:US
Mailing Address - Phone:917-864-7862
Mailing Address - Fax:
Practice Address - Street 1:1918 1ST AVE APT 804
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-7480
Practice Address - Country:US
Practice Address - Phone:917-864-7862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY555767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse