Provider Demographics
NPI:1790586493
Name:JORDAN, SHALONDA Y
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:Y
Last Name:JORDAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 OAKMERE DR
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-1531
Mailing Address - Country:US
Mailing Address - Phone:424-800-1918
Mailing Address - Fax:
Practice Address - Street 1:505 W 109TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-4309
Practice Address - Country:US
Practice Address - Phone:424-800-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker