Provider Demographics
NPI:1356614663
Name:CORMIER, SHALONDA MICHELLE (LSA)
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:MICHELLE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18623 ANDERWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2305
Mailing Address - Country:US
Mailing Address - Phone:281-561-5912
Mailing Address - Fax:
Practice Address - Street 1:18623 ANDERWOOD FOREST DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2305
Practice Address - Country:US
Practice Address - Phone:281-561-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2019-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00562246ZC0007X
TX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant