Healthcare Provider Details

I. General information

NPI: 1710780697
Provider Name (Legal Business Name): TAMIKA DESHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8328 MYRTLE LN APT A
LIBERTY TOWNSHIP OH
45044-1107
US

IV. Provider business mailing address

8328 MYRTLE LN APT A
LIBERTY TOWNSHIP OH
45044-1107
US

V. Phone/Fax

Practice location:
  • Phone: 313-629-5815
  • Fax:
Mailing address:
  • Phone: 313-629-5815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: