Healthcare Provider Details

I. General information

NPI: 1114695863
Provider Name (Legal Business Name): SHARMA LATRICE GODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 LINDEN AVE
DAYTON OH
45432-3015
US

IV. Provider business mailing address

4130 LINDEN AVE
DAYTON OH
45432-3015
US

V. Phone/Fax

Practice location:
  • Phone: 937-479-9797
  • Fax:
Mailing address:
  • Phone: 937-479-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: