Provider Demographics
NPI:1295870210
Name:DORSE, SHANDORA ALLISA (PA-C)
Entity type:Individual
Prefix:MS
First Name:SHANDORA
Middle Name:ALLISA
Last Name:DORSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1005 LONSWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5522
Mailing Address - Country:US
Mailing Address - Phone:615-360-8852
Mailing Address - Fax:615-898-5004
Practice Address - Street 1:1500 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37132-3100
Practice Address - Country:US
Practice Address - Phone:615-898-2310
Practice Address - Fax:615-898-5004
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN184363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical