Healthcare Provider Details

I. General information

NPI: 1588488373
Provider Name (Legal Business Name): TAMIKA SHAWNDALYNNE BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19201 VAN AKEN BLVD APT 503
SHAKER HEIGHTS OH
44122-3511
US

IV. Provider business mailing address

19201 VAN AKEN BLVD APT 503
SHAKER HEIGHTS OH
44122-3511
US

V. Phone/Fax

Practice location:
  • Phone: 216-333-5060
  • Fax:
Mailing address:
  • Phone: 216-333-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: