Healthcare Provider Details

I. General information

NPI: 1306435367
Provider Name (Legal Business Name): SHERLY LABORDE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 ANDORA CT
KISSIMMEE FL
34758-3910
US

IV. Provider business mailing address

54 ANDORA CT
KISSIMMEE FL
34758-3910
US

V. Phone/Fax

Practice location:
  • Phone: 140-361-8552
  • Fax:
Mailing address:
  • Phone: 140-736-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9426825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: