MEDICARE: SHARDENA THOMPSON

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	372500000X	Chore Provider
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.165167	OH

General Provider Information

NPI Number	:	1427829118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARDENA THOMPSON

Provider Business Mailing Address
First Line	:	10403 SOUTH BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3451
Country	:	US
Telephone Number	:	216-731-6284
Fax Number	:

Provider Business Practice Location Address
First Line	:	10403 SOUTH BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3451
Country	:	US
Telephone Number	:	216-731-6284
Fax Number	:

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	04/23/2026

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Directions to “ SHARDENA THOMPSON ” Practice Location

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