Provider Demographics
NPI:1104372564
Name:SANDFORD, SHAUNA LYNN (NP)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LYNN
Last Name:SANDFORD
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 1:685 NATURELAND CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3309
Mailing Address - Country:US
Mailing Address - Phone:303-667-5019
Mailing Address - Fax:
Practice Address - Street 1:50 CYPRESS POINT PKWY STE B1
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2501
Practice Address - Country:US
Practice Address - Phone:386-283-4180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.099058-NP363LW0102X
FLAPRN11010920364SW0102X
CORN.0205262163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse