Provider Demographics
NPI:1427563220
Name:SHARDON, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHARDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 WESTCHESTER DR STE 213
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6116
Mailing Address - Country:US
Mailing Address - Phone:214-295-8213
Mailing Address - Fax:
Practice Address - Street 1:8215 WESTCHESTER DR STE 213
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6116
Practice Address - Country:US
Practice Address - Phone:214-295-8213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty