Provider Demographics
NPI:1053097329
Name:DAVIS, SHARON HENRIETTA
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:HENRIETTA
Last Name:DAVIS
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 1:377 HEATHERBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9278
Mailing Address - Country:US
Mailing Address - Phone:614-579-7558
Mailing Address - Fax:
Practice Address - Street 1:377 HEATHERBRIDGE LN
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9278
Practice Address - Country:US
Practice Address - Phone:614-579-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide