Active NPI
Sandra D. Shanaberger, P.A.-C.
- Medical Physician Assistant
- Louisville, KY
National Provider Identifier
1730284076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA432
- Practice address
- 1009A N Dupont SQ
Louisville, KY 40207-4612 - Phone
- (502) 894-9950
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA432 | KY | Primary |
Addresses
Primary practice location
1009A N Dupont SQ
Louisville, KY 40207-4612
Mailing address
4011 Leland Rd
Louisville, KY 40207-2007
Phone (859) 699-9946
Other practice location 1
33920 US 19 N
Suite 241
Palm Harbor, FL 34684-2654
Phone (727) 773-9793
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 970021516 | Other | KY | RR MEDICARE PIN |
| CB5773 | Other | KY | RR MEDICARE GROUP |
| 37903705 | Other | KY | MEDICAID LAB GROUP |
| 4000501 | Other | KY | MEDICARE LAB GROUP |
| 95001640 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580947200000",
"number": "1730284076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4011 LELAND RD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402072007",
"telephone_number": "859-699-9946",
"fax_number": "502-894-9991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1009A N DUPONT SQ",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402074612",
"telephone_number": "502-894-9950"
}
],
"practiceLocations": [
{
"address_1": "33920 US 19 N",
"address_2": "Suite 241",
"address_purpose": "LOCATION",
"city": "Palm Harbor",
"state": "FL",
"postal_code": "346842654",
"country_code": "US",
"telephone_number": "727-773-9793",
"fax_number": "727-773-0674",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHANABERGER",
"first_name": "SANDRA",
"middle_name": "D.",
"credential": "P.A.-C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2020-02-06",
"certification_date": "2020-02-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KY",
"license": "PA432",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE PIN",
"identifier": "970021516",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP",
"identifier": "CB5773",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID LAB GROUP",
"identifier": "37903705",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE LAB GROUP",
"identifier": "4000501",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "95001640",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.