Provider Demographics
NPI:1255523999
Name:BOYD, SHALONDA MICHELLE-LEE (LPN)
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:MICHELLE-LEE
Last Name:BOYD
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 1:1930 W 79TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3022
Mailing Address - Country:US
Mailing Address - Phone:317-222-5255
Mailing Address - Fax:
Practice Address - Street 1:1930 W 79TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-3022
Practice Address - Country:US
Practice Address - Phone:317-222-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27057648A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse