Provider Demographics
NPI:1336928571
Name:SHANDER, SABRINA ELISE (CRNP)
Entity type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:ELISE
Last Name:SHANDER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:SABRINA
Other - Middle Name:ELISE
Other - Last Name:MUCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 JESSUP AVE
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434-1116
Mailing Address - Country:US
Mailing Address - Phone:570-983-6674
Mailing Address - Fax:
Practice Address - Street 1:1839 FAIR AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2121
Practice Address - Country:US
Practice Address - Phone:570-251-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily