Provider Demographics
NPI:1871371559
Name:BAGWELL, SHARONDA LASHAWN (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SHARONDA
Middle Name:LASHAWN
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 PRESIDENT AVE STE 3001
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5928
Mailing Address - Country:US
Mailing Address - Phone:682-231-0816
Mailing Address - Fax:
Practice Address - Street 1:1030 PRESIDENT AVE STE 3001
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5928
Practice Address - Country:US
Practice Address - Phone:682-231-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN04363363LP0808X
NY405360363LP0808X
MARN2389758163W00000X, 363LP0808X
TX814208163W00000X
TX1138077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse