Provider Demographics
NPI:1720356520
Name:SHAVINGS, AMANDA (PDHA 1)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:SHAVINGS
Suffix:
Gender:F
Credentials:PDHA 1
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PDHA 1
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:MEKORYUK
Mailing Address - State:AK
Mailing Address - Zip Code:99630-0086
Mailing Address - Country:US
Mailing Address - Phone:907-827-2078
Mailing Address - Fax:907-827-8351
Practice Address - Street 1:829 CHIEF EDDIE HOFFMAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:AK
Practice Address - Zip Code:99559-0528
Practice Address - Country:US
Practice Address - Phone:907-827-8111
Practice Address - Fax:907-827-8351
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11-082-PDHA11223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK11-082-PDHA1OtherPDHA 1 CERTIFICATION NUMBER