Provider Demographics
NPI:1629747084
Name:PEARCE, SHADAE LASHONDA (RN)
Entity Type:Individual
Prefix:
First Name:SHADAE
Middle Name:LASHONDA
Last Name:PEARCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177A E MAIN ST # 458
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5711
Mailing Address - Country:US
Mailing Address - Phone:718-772-2540
Mailing Address - Fax:
Practice Address - Street 1:117A E MAIN STREET
Practice Address - Street 2:458
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5711
Practice Address - Country:US
Practice Address - Phone:718-772-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY821653163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse