Provider Demographics
NPI:1306125091
Name:EVANS, SHALONDRA (LPN)
Entity type:Individual
Prefix:
First Name:SHALONDRA
Middle Name:
Last Name:EVANS
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 1:112 ROOSEVELT AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2839
Mailing Address - Country:US
Mailing Address - Phone:716-603-0451
Mailing Address - Fax:
Practice Address - Street 1:2250 WEHRLE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7034
Practice Address - Country:US
Practice Address - Phone:716-276-2123
Practice Address - Fax:716-276-2129
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284420164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse