Provider Demographics
NPI:1407099435
Name:VELEZ, SHARDAE MONIQUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHARDAE
Middle Name:MONIQUE
Last Name:VELEZ
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 1:77 FAWN DR APT 307
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-6156
Mailing Address - Country:US
Mailing Address - Phone:513-290-5354
Mailing Address - Fax:
Practice Address - Street 1:77 FAWN DR APT 307
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-6156
Practice Address - Country:US
Practice Address - Phone:513-290-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128663164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse