Provider Demographics
NPI:1902393101
Name:SMITH, SHARDE NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:SHARDE
Middle Name:NICOLE
Last Name:SMITH
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 1:116 GENUNG ST APT 1N
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5304
Mailing Address - Country:US
Mailing Address - Phone:845-978-6206
Mailing Address - Fax:
Practice Address - Street 1:116 GENUNG ST APT 1N
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5304
Practice Address - Country:US
Practice Address - Phone:845-978-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330273164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty