Healthcare Provider Details

I. General information

NPI: 1386135200
Provider Name (Legal Business Name): SHALEKA MERCEDES CAMERON STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2018
Last Update Date: 05/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 JOHNSON AVE APT C
ALLIANCE OH
44601
US

IV. Provider business mailing address

1314 JOHNSON AVE APT C
ALLIANCE OH
44601-1171
US

V. Phone/Fax

Practice location:
  • Phone: 330-428-1857
  • Fax:
Mailing address:
  • Phone: 330-428-1857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401579711013
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: