Provider Demographics
NPI:1316305469
Name:EDWARDS, SHAMADA
Entity type:Individual
Prefix:
First Name:SHAMADA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22307 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2737
Mailing Address - Country:US
Mailing Address - Phone:718-749-8093
Mailing Address - Fax:718-949-0196
Practice Address - Street 1:22307 CARSON ST
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2737
Practice Address - Country:US
Practice Address - Phone:718-749-8093
Practice Address - Fax:718-949-0196
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2025-10-01
Deactivation Date:2019-12-10
Deactivation Code:
Reactivation Date:2025-10-01
Provider Licenses
StateLicense IDTaxonomies
NY324677164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse