Provider Demographics
NPI:1124496179
Name:HARDY, O SHEA EVERAJN (LPN)
Entity type:Individual
Prefix:MRS
First Name:O SHEA
Middle Name:EVERAJN
Last Name:HARDY
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 1:4220 HUTCHINSON RIVER PKWY E
Mailing Address - Street 2:APT 16E BLG 29B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4726
Mailing Address - Country:US
Mailing Address - Phone:347-867-6056
Mailing Address - Fax:
Practice Address - Street 1:4220 HUTCHINSON RIVER PKWY E
Practice Address - Street 2:APT 16E BLG 29B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4726
Practice Address - Country:US
Practice Address - Phone:347-867-6056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323285164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse