MEDICARE: SACORRA SHALOND NED

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1184394132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SACORRA SHALOND NED

Provider Business Mailing Address
First Line	:	9740 SURREY RUN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-2108
Country	:	US
Telephone Number	:	719-321-0163
Fax Number	:

Provider Business Practice Location Address
First Line	:	9740 SURREY RUN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-2108
Country	:	US
Telephone Number	:	719-321-0163
Fax Number	:

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

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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Directions to “ SACORRA SHALOND NED ” Practice Location

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