Provider Demographics
NPI:1437392933
Name:COOPER, SHARIA SHONDALE (LPN)
Entity type:Individual
Prefix:
First Name:SHARIA
Middle Name:SHONDALE
Last Name:COOPER
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 1:331 TRINDALE DRIVE
Mailing Address - Street 2:SITE D 201
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2933
Mailing Address - Country:US
Mailing Address - Phone:336-404-9956
Mailing Address - Fax:
Practice Address - Street 1:5205 SWITCHBACK DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2933
Practice Address - Country:US
Practice Address - Phone:336-404-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NC065680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No251E00000XAgenciesHome Health