Provider Demographics
NPI:1063157733
Name:LEONARD, SHANDEL (NP)
Entity type:Individual
Prefix:
First Name:SHANDEL
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 FOX SQUIRREL CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-4481
Mailing Address - Country:US
Mailing Address - Phone:803-960-3423
Mailing Address - Fax:
Practice Address - Street 1:336 FOX SQUIRREL CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-4481
Practice Address - Country:US
Practice Address - Phone:803-960-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily