Provider Demographics
NPI:1932307139
Name:SHOMODY, SERENA R (DPM)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:R
Last Name:SHOMODY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:SERENA
Other - Middle Name:ROSE
Other - Last Name:LETENDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:590 COURT ST
Mailing Address - Street 2:DARTMOUTH HITCHCOCK - PODIATRY
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1719
Mailing Address - Country:US
Mailing Address - Phone:603-354-5454
Mailing Address - Fax:
Practice Address - Street 1:590 COURT ST
Practice Address - Street 2:DARTMOUTH HITCHCOCK - PODIATRY
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1719
Practice Address - Country:US
Practice Address - Phone:603-354-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0318213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30366159Medicaid
NH30366159Medicaid