Provider Demographics
NPI:1265834246
Name:BELLAGOSI, SHARLEECE (LPN)
Entity Type:Individual
Prefix:
First Name:SHARLEECE
Middle Name:
Last Name:BELLAGOSI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-6039
Mailing Address - Country:US
Mailing Address - Phone:888-503-3725
Mailing Address - Fax:888-503-6687
Practice Address - Street 1:3801 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-6039
Practice Address - Country:US
Practice Address - Phone:888-503-3725
Practice Address - Fax:888-503-6687
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-21
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO-007651251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care