Provider Demographics
NPI:1518786136
Name:WILRIDGE, SHANADRA
Entity type:Individual
Prefix:
First Name:SHANADRA
Middle Name:
Last Name:WILRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31506 TARA BLVD W
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-5100
Mailing Address - Country:US
Mailing Address - Phone:346-261-7396
Mailing Address - Fax:
Practice Address - Street 1:31506 TARA BLVD W
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-5100
Practice Address - Country:US
Practice Address - Phone:346-261-7396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider