Provider Demographics
NPI:1639430838
Name:GAUDARD, BELINEDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:BELINEDA
Middle Name:
Last Name:GAUDARD
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 1:14834 231ST ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-4243
Mailing Address - Country:US
Mailing Address - Phone:718-276-7101
Mailing Address - Fax:
Practice Address - Street 1:14834 231ST ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-4243
Practice Address - Country:US
Practice Address - Phone:718-276-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309388164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse