Provider Demographics
NPI:1063098788
Name:LIDONDE, SHARI HALIMA (LPN)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:HALIMA
Last Name:LIDONDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOSTON POST RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2578
Mailing Address - Country:US
Mailing Address - Phone:339-213-1987
Mailing Address - Fax:
Practice Address - Street 1:415 BOSTON POST RD STE 3
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2578
Practice Address - Country:US
Practice Address - Phone:339-213-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39315364S00000X
MA92614364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist