Provider Demographics
NPI:1831579853
Name:SHRADER, SHANDA THOMAS (CPNP-PC)
Entity type:Individual
Prefix:
First Name:SHANDA
Middle Name:THOMAS
Last Name:SHRADER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:SUZANNE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-627-9350
Mailing Address - Fax:352-273-9054
Practice Address - Street 1:27550 STATE HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-3203
Practice Address - Country:US
Practice Address - Phone:205-625-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134326363LP0200X
GA208000000X363LP0200X
FLAPRN11025689363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics