MEDICARE: SHARONDA NEAL RN

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	163WH0200X	Home Health Registered Nurse	RN0000213056	TN

General Provider Information

NPI Number	:	1558904656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARONDA NEAL RN

Provider Business Mailing Address
First Line	:	PO BOX 812
Second Line	:
City	:	ELLENDALE
State	:	TN
Zip	:	38029-0812
Country	:	US
Telephone Number	:	901-606-1784
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 ROCKBRIDGE RD
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-4768
Country	:	US
Telephone Number	:	901-606-1784
Fax Number	:

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

Provider Enumeration Date	:	10/21/2019
Last Update Date	:	10/14/2020

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