Provider Demographics
NPI:1487469623
Name:MATTHEWS, SHRONDA RENA
Entity type:Individual
Prefix:MS
First Name:SHRONDA
Middle Name:RENA
Last Name:MATTHEWS
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 1:8810 C AVE
Mailing Address - Street 2:UINT 130
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-1566
Mailing Address - Country:US
Mailing Address - Phone:909-837-8885
Mailing Address - Fax:
Practice Address - Street 1:8810 C AVE
Practice Address - Street 2:UINT 130
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-1566
Practice Address - Country:US
Practice Address - Phone:909-837-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376J00000X, 372500000X, 372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion