Provider Demographics
NPI:1427859610
Name:STANFIELD, SHAMIRROR L (BSHA, LPN,CDP, ALR,)
Entity type:Individual
Prefix:MS
First Name:SHAMIRROR
Middle Name:L
Last Name:STANFIELD
Suffix:
Gender:
Credentials:BSHA, LPN,CDP, ALR,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 WYNCOTE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-3136
Mailing Address - Country:US
Mailing Address - Phone:267-694-2343
Mailing Address - Fax:
Practice Address - Street 1:6732 WYNCOTE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-3136
Practice Address - Country:US
Practice Address - Phone:267-694-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN302336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse