Provider Demographics
NPI:1740494517
Name:HARDING, SHERLEEN A (APRN)
Entity type:Individual
Prefix:
First Name:SHERLEEN
Middle Name:A
Last Name:HARDING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ALBION ST
Mailing Address - Street 2:SOUTHWEST COMMUNITY HEALTH CENTER, INC
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2804
Mailing Address - Country:US
Mailing Address - Phone:203-332-3155
Mailing Address - Fax:203-330-6008
Practice Address - Street 1:968 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1116
Practice Address - Country:US
Practice Address - Phone:203-330-6000
Practice Address - Fax:203-382-9425
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCHN9023OtherCOMMUNITY HEALTH CENTER
CT1699703686OtherANTHEM BLUE CROSS AND BLUE SHIELD
CT003556OtherSTATE LICENSE
CT008010617Medicaid
CTCHN9023OtherCOMMUNITY HEALTH CENTER
CT500002253Medicare PIN