Provider Demographics
NPI:1821644097
Name:EDMOND, SHERONDA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:SHERONDA
Middle Name:NICOLE
Last Name:EDMOND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHERONDA
Other - Middle Name:NICOLE
Other - Last Name:EDMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHERONDA COOK
Mailing Address - Street 1:1634 BELMAR RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1156
Mailing Address - Country:US
Mailing Address - Phone:216-456-5291
Mailing Address - Fax:
Practice Address - Street 1:1634 BELMAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1156
Practice Address - Country:US
Practice Address - Phone:216-456-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157080-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty