Provider Demographics
NPI:1295706554
Name:MENDES, SHIRLEY A (APRN)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:A
Last Name:MENDES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:270 MOHEGAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4125
Mailing Address - Country:US
Mailing Address - Phone:860-439-2275
Mailing Address - Fax:860-439-5430
Practice Address - Street 1:270 MOHEGAN AVENUE
Practice Address - Street 2:WARNSHUIS BUILDING
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4125
Practice Address - Country:US
Practice Address - Phone:860-439-2275
Practice Address - Fax:860-439-5430
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005194363LF0000X
RINP28042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1295706554Medicaid
S90797Medicare UPIN