Provider Demographics
NPI:1215522966
Name:SHOURDS, SAVANNAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:
Last Name:SHOURDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:SHOURDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:2250 NW 136TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2628
Mailing Address - Country:US
Mailing Address - Phone:954-302-7960
Mailing Address - Fax:
Practice Address - Street 1:2250 NW 136TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2628
Practice Address - Country:US
Practice Address - Phone:954-302-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9114068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant