MEDICARE: SHED-LAURE RICHARDSON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11043971	FL

General Provider Information

NPI Number	:	1528922556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHED-LAURE RICHARDSON

Provider Business Mailing Address
First Line	:	318 SW 79TH WAY
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-1131
Country	:	US
Telephone Number	:	954-839-5474
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 SW 79TH WAY
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-1131
Country	:	US
Telephone Number	:	954-839-5474
Fax Number	:

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

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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Directions to “ SHED-LAURE RICHARDSON ” Practice Location

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