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General NPI Number Information
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NPI Number | 1871371559
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Entity Type | Individual
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Provider Name | SHARONDA LASHAWN BAGWELL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 109 RHODE ISLAND RD STE 4B
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City | LAKEVILLE
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State | MA
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Zip | 02347-1370
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Country | US
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Telephone | 774-209-2372
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Fax | 774-217-7242
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Provider Business Mailing Address
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Address Line | 109 RHODE ISLAND RD STE 4B
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City | LAKEVILLE
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State | MA
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Zip | 02347-1370
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Country | US
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Telephone | 774-209-2372
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Fax | 774-217-7242
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1138077
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 405360
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN04363
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License Number State | RI
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN2389758
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License Number State | MA
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