Provider Demographics
NPI:1033477757
Name:VILLANI, SHANDY (IDMT)
Entity type:Individual
Prefix:MISS
First Name:SHANDY
Middle Name:
Last Name:VILLANI
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:SHANDY
Other - Middle Name:
Other - Last Name:GORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDMT
Mailing Address - Street 1:31ST MEDICAL GROUP/SGST
Mailing Address - Street 2:UNIT 6180
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09604-6180
Mailing Address - Country:US
Mailing Address - Phone:719-428-8484
Mailing Address - Fax:
Practice Address - Street 1:31ST MEDICAL GROUP/SGST
Practice Address - Street 2:UNIT 6180
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09604-6180
Practice Address - Country:US
Practice Address - Phone:719-428-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians