Provider Demographics
NPI:1053293175
Name:LUKONDE, SHUDEL
Entity type:Individual
Prefix:
First Name:SHUDEL
Middle Name:
Last Name:LUKONDE
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 1:6445 S WARWICKSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-6585
Mailing Address - Country:US
Mailing Address - Phone:415-530-1352
Mailing Address - Fax:
Practice Address - Street 1:6445 S WARWICKSHIRE AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-6585
Practice Address - Country:US
Practice Address - Phone:415-530-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion