Provider Demographics
NPI:1912681966
Name:SANDERS, SHANNON BROOKE (CHD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:BROOKE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:CHD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHD
Mailing Address - Street 1:3509 PAMPAS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-5221
Mailing Address - Country:US
Mailing Address - Phone:469-987-4179
Mailing Address - Fax:
Practice Address - Street 1:3509 PAMPAS CREEK DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-5221
Practice Address - Country:US
Practice Address - Phone:469-987-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula