Healthcare Provider Details

I. General information

NPI: 1356053847
Provider Name (Legal Business Name): SHARI NICOLE MOORE CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WADSWORTH RD
WADSWORTH OH
44281-9580
US

IV. Provider business mailing address

104 SPINK ST
WOOSTER OH
44691-3652
US

V. Phone/Fax

Practice location:
  • Phone: 234-217-8882
  • Fax:
Mailing address:
  • Phone: 330-264-8498
  • Fax: 330-264-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: