Provider Demographics
NPI:1912436288
Name:SHALDERS, GLORIA (MSHA, BSN, APRN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:SHALDERS
Suffix:
Gender:F
Credentials:MSHA, BSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11176 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2661
Mailing Address - Country:US
Mailing Address - Phone:754-242-1900
Mailing Address - Fax:
Practice Address - Street 1:55 DAVID TER APT 19
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3968
Practice Address - Country:US
Practice Address - Phone:781-975-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9278096163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1912436288Medicaid