Basic Information
| Provider Information | |||||||||
| NPI: | 1053705392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | SHEARITA | ||||||||
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| Credential: | ANP- BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5471 DR. MARTIN LUTHER KING DR. | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631124265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143675820 | ||||||||
| FaxNumber: | 3143676326 | ||||||||
| Practice Location | |||||||||
| Address1: | 3113 MAGNOLIA AVE | ||||||||
| Address2: | APT 2E | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631181271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147496708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 2014043293 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.