Healthcare Provider Details

I. General information

NPI: 1649957697
Provider Name (Legal Business Name): MRS. SHACOREY TYANTE' HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 CRANDALL AVE
YOUNGSTOWN OH
44504-1710
US

IV. Provider business mailing address

255 CRANDALL AVE
YOUNGSTOWN OH
44504-1710
US

V. Phone/Fax

Practice location:
  • Phone: 234-855-9888
  • Fax:
Mailing address:
  • Phone: 234-855-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: