MEDICARE: MRS. TAMIKA SHAVON STARKS TAMIKA SERVICE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	347C00000X	Private Vehicle	VA
2	172A00000X	Driver	VA
3	374U00000X	Home Health Aide

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	822907611	OTHER	VA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649782657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMIKA SHAVON STARKS TAMIKA SERVICE LLC

Provider Business Mailing Address
First Line	:	4134 LEAKED AVENUE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224
Country	:	US
Telephone Number	:	804-616-5473
Fax Number	:

Provider Business Practice Location Address
First Line	:	4134 LEAKED AVENUE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224
Country	:	US
Telephone Number	:	804-616-5473
Fax Number	:

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

Provider Enumeration Date	:	10/31/2017
Last Update Date	:	04/19/2018

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Directions to “ MRS. TAMIKA SHAVON STARKS TAMIKA SERVICE LLC” Practice Location

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