Provider Demographics
NPI:1043565005
Name:COSTELLO, SHARNIKA DENISE
Entity Type:Individual
Prefix:
First Name:SHARNIKA
Middle Name:DENISE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 EMERSON ST NW
Mailing Address - Street 2:102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-6931
Mailing Address - Country:US
Mailing Address - Phone:202-710-8793
Mailing Address - Fax:
Practice Address - Street 1:1325 EMERSON ST NW
Practice Address - Street 2:102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6931
Practice Address - Country:US
Practice Address - Phone:202-710-8793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2881640163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health