Provider Demographics
NPI:1700555430
Name:SANDERS, SHAWN DEMETRA
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DEMETRA
Last Name:SANDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 MANGO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-4003
Mailing Address - Country:US
Mailing Address - Phone:281-384-3990
Mailing Address - Fax:
Practice Address - Street 1:9901 MANGO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4003
Practice Address - Country:US
Practice Address - Phone:281-384-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver