Provider Demographics
NPI:1306544960
Name:SANDERS, SHAWNICA T (PRC)
Entity type:Individual
Prefix:
First Name:SHAWNICA
Middle Name:T
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 W 700 S STE B
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84087-1438
Mailing Address - Country:US
Mailing Address - Phone:801-292-2318
Mailing Address - Fax:801-295-2556
Practice Address - Street 1:763 W 700 S STE B
Practice Address - Street 2:
Practice Address - City:WOODS CROSS
Practice Address - State:UT
Practice Address - Zip Code:84087-1438
Practice Address - Country:US
Practice Address - Phone:801-292-2318
Practice Address - Fax:801-295-2556
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker