=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912445107
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHRONDA MATTHEWS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2017
-----------------------------------------------------
Last Update Date | 03/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 564 THOMAS SHERWIN AVE S
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33974-0565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-309-3384
-----------------------------------------------------
Fax | 239-369-8788
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 564 THOMAS SHERWIN AVE S
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33974-0565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-309-3384
-----------------------------------------------------
Fax | 239-369-8788
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------