MEDICARE: THERESA SHARNELL BRAZILE

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1154003994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA SHARNELL BRAZILE

Provider Business Mailing Address
First Line	:	1620 SUMMIT RD APT 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2031
Country	:	US
Telephone Number	:	513-616-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 SUMMIT RD APT 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2031
Country	:	US
Telephone Number	:	513-616-1113
Fax Number	:

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

Provider Enumeration Date	:	08/02/2023
Last Update Date	:	08/02/2023

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