MEDICARE: SHARNIKA DENISE COSTELLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	2881640	DC

General Provider Information

NPI Number	:	1043565005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARNIKA DENISE COSTELLO

Provider Business Mailing Address
First Line	:	1325 EMERSON ST NW
Second Line	:	102
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6931
Country	:	US
Telephone Number	:	202-710-8793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 EMERSON ST NW
Second Line	:	102
City	:	WASHINGTON
State	:	DC
Zip	:	20011-6931
Country	:	US
Telephone Number	:	202-710-8793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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Directions to “ SHARNIKA DENISE COSTELLO ” Practice Location

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