SHANDAREDA SEWELL (NPI# 1538319249) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538319249 |
| Entity Type | Individual |
| Full Name | SHANDAREDA SEWELL |
| Credential | PA |
| Practice Address |
325 N Jeff Davis Dr Fayetteville GA 30214-1627 |
| Mailing Address |
11 Upper Riverdale Rd Sw Riverdale GA 30274-2615 |
| Practice Telephone | 7704617337 |
| Practice Fax Number | 7704610922 |
| Mailing Telephone | 7709963190 |
| Mailing Fax Number | 7709963529 |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2017-11-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 004742 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 364SP1700X |
Clinical Nurse Specialist Specialization: Perinatal |
004742 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
325 N JEFF DAVIS DR |
| City | FAYETTEVILLE |
| State | GA |
| Zip Code | 30214-1627 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144331042 | Stephen P Auda | Specialist | 325 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2006-08-31 |
| 1568861268 | Southern Crescent Physicians Group, Inc. | Surgery | 325 N Jeff Davis Dr, Fayetteville, GA 30214-1627 | 2014-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548872468 | Phyllis Kelly Wood | Nurse Practitioner | 217 Banks Rd, Suite 31, Fayetteville, GA 30214 | 2020-08-21 |
| 1073139317 | Tyisha Salter Scott | Counselor | 110 Habersham Drive, Suite 142, Fayetteville, GA 30214 | 2020-06-23 |
| 1194341412 | Camille Franncine Bolton | Physical Therapist | 500 Floy Farr Parkway, Suite 303, Fayetteville, GA 30214 | 2020-06-23 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1881234557 | Peach Fits,inc | Mastectomy Fitter | 285 Glynn Street South, Suites 102 and 104, Fayetteville, GA 30214 | 2020-01-10 |
| 1255981072 | Delta Healthcare Providers | Clinic/Center | 1275 W Lanier Ave, #200, Fayetteville, GA 30214 | 2019-09-13 |
| 1861965592 | Hierarchy for Wellness | Specialist | 805 S Glynn St Bldg 127 142, Fayetteville, GA 30214 | 2019-01-04 |
| 1356810634 | Fayette Dental Group PC | Clinic/Center | 720 W Lanier Ave, Fayetteville, GA 30214 | 2018-11-16 |
| 1891263299 | Mattie Mae Farmer Clark | Specialist/Technologist, Other | Piedmont Fayette Hospital, 1255 Highway 54 West, Fayetteville, GA 30214 | 2018-11-05 |
| 1093293607 | Allyson Holland | Pharmacist | 880 Highway 85 South, Fayetteville, GA 30214 | 2018-08-06 |
| Find all providers in zip 30214 | ||||
| Taxonomy Code | 364SP1700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Perinatal |
| Definition to come... |
| City | FAYETTEVILLE |
| Zip Code | 30214 |
Please comment or provide details below to improve the information on SHANDAREDA SEWELL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.