Provider Demographics
NPI:1679084529
Name:HARDY, SHAKEDRA
Entity type:Individual
Prefix:
First Name:SHAKEDRA
Middle Name:
Last Name:HARDY
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 1:470 E 3RD ST SUITE C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-2729
Mailing Address - Country:US
Mailing Address - Phone:213-223-5922
Mailing Address - Fax:323-897-5334
Practice Address - Street 1:4601 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-2729
Practice Address - Country:US
Practice Address - Phone:213-223-5922
Practice Address - Fax:323-897-5334
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker