Provider Demographics
NPI:1043802515
Name:GRIM, SHAUNICE MICHELLE
Entity Type:Individual
Prefix:
First Name:SHAUNICE
Middle Name:MICHELLE
Last Name:GRIM
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 1:9420 TOWNE SQUARE AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6910
Mailing Address - Country:US
Mailing Address - Phone:513-834-8111
Mailing Address - Fax:
Practice Address - Street 1:9420 TOWNE SQUARE AVE STE 20
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-6910
Practice Address - Country:US
Practice Address - Phone:513-834-8111
Practice Address - Fax:800-854-8883
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty