Provider Demographics
NPI:1255779559
Name:KENDALL, SHALONDA RAYNE (STNA)
Entity type:Individual
Prefix:MS
First Name:SHALONDA
Middle Name:RAYNE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WINTER LANE PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7517
Mailing Address - Country:US
Mailing Address - Phone:614-649-3344
Mailing Address - Fax:
Practice Address - Street 1:3420 WINTER LANE PARK
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7517
Practice Address - Country:US
Practice Address - Phone:614-649-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400866940209376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide