MEDICARE: SHARONDA A COLEMAN

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	363LF0000X	Family Nurse Practitioner	209023715	IL
2	363LF0000X	Family Nurse Practitioner	2021021440	MO

General Provider Information

NPI Number	:	1588324727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARONDA A COLEMAN

Provider Business Mailing Address
First Line	:	5132 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-2429
Country	:	US
Telephone Number	:	847-235-6130
Fax Number	:	847-941-0577

Provider Business Practice Location Address
First Line	:	9500 BELLEFONTAINE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1336
Country	:	US
Telephone Number	:	314-388-0796
Fax Number	:

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

Provider Enumeration Date	:	12/29/2021
Last Update Date	:	12/29/2021

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Directions to “ SHARONDA A COLEMAN ” Practice Location

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