Basic Information
| Provider Information | |||||||||
| NPI: | 1275578940 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUFFETT | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | ROBBIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 910670 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405910670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599714685 | ||||||||
| FaxNumber: | 8599714602 | ||||||||
| Practice Location | |||||||||
| Address1: | 1760 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592606537 | ||||||||
| FaxNumber: | 8592604151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 045394 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 43771 | KY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 7100146460 | 05 | KY | MEDICAID |