Provider Demographics
NPI:1235967654
Name:COLEMAN, SALONDA
Entity type:Individual
Prefix:
First Name:SALONDA
Middle Name:
Last Name:COLEMAN
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 1:4230 N OAKLAND AVE # 167
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2042
Mailing Address - Country:US
Mailing Address - Phone:414-416-2169
Mailing Address - Fax:
Practice Address - Street 1:4230 N OAKLAND AVE # 167
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2042
Practice Address - Country:US
Practice Address - Phone:414-416-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)