Provider Demographics
NPI:1053811125
Name:EDWARDS, SHANIKA
Entity type:Individual
Prefix:
First Name:SHANIKA
Middle Name:
Last Name:EDWARDS
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 1:2815 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-2716
Mailing Address - Country:US
Mailing Address - Phone:317-956-0226
Mailing Address - Fax:
Practice Address - Street 1:2815 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-2716
Practice Address - Country:US
Practice Address - Phone:317-956-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No374U00000XNursing Service Related ProvidersHome Health Aide