Provider Demographics
NPI:1538627542
Name:HOPPER, SHALONDA LAVETTE
Entity type:Individual
Prefix:
First Name:SHALONDA
Middle Name:LAVETTE
Last Name:HOPPER
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 1:197 BLUEBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-7379
Mailing Address - Country:US
Mailing Address - Phone:704-419-9872
Mailing Address - Fax:
Practice Address - Street 1:197 BLUEBIRD LN
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7379
Practice Address - Country:US
Practice Address - Phone:704-419-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care