Provider Demographics
NPI:1992038632
Name:LIPFORD, SHONDA LATOYA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHONDA
Middle Name:LATOYA
Last Name:LIPFORD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:SHONDA
Other - Middle Name:LATOYA
Other - Last Name:MAHONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:154 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2325
Mailing Address - Country:US
Mailing Address - Phone:585-520-0214
Mailing Address - Fax:
Practice Address - Street 1:154 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2325
Practice Address - Country:US
Practice Address - Phone:585-520-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276150-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse