Healthcare Provider Details

I. General information

NPI: 1659207074
Provider Name (Legal Business Name): TIEARRIA SHURILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 LINDEL LN
INDIANAPOLIS IN
46268-2796
US

IV. Provider business mailing address

7374 BADGER CT
INDIANAPOLIS IN
46260-5278
US

V. Phone/Fax

Practice location:
  • Phone: 317-391-4298
  • Fax:
Mailing address:
  • Phone: 317-903-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: