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
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Other - First Name:
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Mailing Address - Street 1:109 RHODE ISLAND RD STE 4B
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1370
Mailing Address - Country:US
Mailing Address - Phone:774-209-2372
Mailing Address - Fax:774-217-7242
Practice Address - Street 1:109 RHODE ISLAND RD STE 4B
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MA
Practice Address - Zip Code:02347-1370
Practice Address - Country:US
Practice Address - Phone:774-209-2372
Practice Address - Fax:774-217-7242
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1138077363LP0808X, 363LP0808X
NY405360363LP0808X
RIAPRN04363363LP0808X
MARN2389758363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health