Healthcare Provider Details

I. General information

NPI: 1063098788
Provider Name (Legal Business Name): SHARI HALIMA LIDONDE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BOSTON POST RD STE 3
MILFORD CT
06460-2578
US

IV. Provider business mailing address

415 BOSTON POST RD STE 3
MILFORD CT
06460-2578
US

V. Phone/Fax

Practice location:
  • Phone: 339-213-1987
  • Fax:
Mailing address:
  • Phone: 339-213-1987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number39315
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number92614
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: