Sandra M Keavey, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60467722 Issued in WA

Practice address

32605 W 12 Mile Rd Ste 195
Farmington Hills, MI 48334-3390

Phone

(313) 306-2023

NPI assigned

Jun 20, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 3

Other names 1

• Sandra M Shelby Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: skeavey@landmarkhealth-direct.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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  • NPI 1366581761
  NPD (past)
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  • Urgent Care Clinic/Center
  • Raleigh, NC
  • NPI 1225331903
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655251200000",
    "number": "1215932702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16351 ROTUNDA DR",
            "address_2": "#275D",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481201170",
            "telephone_number": "910-709-1488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32605 W 12 MILE RD STE 195",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483343390",
            "telephone_number": "313-306-2023"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Pacific Ave # 210",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984023302",
            "country_code": "US",
            "telephone_number": "253-680-6016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEAVEY",
        "first_name": "SANDRA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601001357",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-03212",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60467722",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60467722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "SK001357",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0010-03212",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "N98340001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "SHELBY",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Anastasia Keast
• Casey Keast, AGNP-C
• Ryan Keating
• Kennedi Keaton
• Zakyiah Keaton
• Elizabeth Keavney
• Gelila Kebede
• Nicole Kedrowski
• Stephanie Keebler
• Tanner Keefer

• Physician Assistant in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.