Healthcare Provider Details

I. General information

NPI: 1972373231
Provider Name (Legal Business Name): SHAMIKA BONITA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 GLENMORE ST
YOUNGSTOWN OH
44505-4127
US

IV. Provider business mailing address

1729 GLENMORE ST
YOUNGSTOWN OH
44505-4127
US

V. Phone/Fax

Practice location:
  • Phone: 330-207-9849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number600747520124
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number600745720124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: