Healthcare Provider Details

I. General information

NPI: 1649782657
Provider Name (Legal Business Name): TAMIKA SHAVON STARKS TAMIKA SERVICE LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TAMIKA SHAVON STARKS

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 LEAKED AVENUE
RICHMOND VA
23224
US

IV. Provider business mailing address

4134 LEAKED AVENUE
RICHMOND VA
23224
US

V. Phone/Fax

Practice location:
  • Phone: 804-616-5473
  • Fax:
Mailing address:
  • Phone: 804-616-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: