MEDICARE: MRS. SHARDAI LENAE JRIDI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SWB-2026-0401	NM

General Provider Information

NPI Number	:	1184313777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARDAI LENAE JRIDI LCSW

Provider Business Mailing Address
First Line	:	1001 W BROADWAY STE D
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-327-4796
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 W BROADWAY # D&E
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5638
Country	:	US
Telephone Number	:	505-327-4796
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	04/06/2026

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