Provider Demographics
NPI:1114277977
Name:SHY-OJO, CHARITA (LPN-IV)
Entity Type:Individual
Prefix:MRS
First Name:CHARITA
Middle Name:
Last Name:SHY-OJO
Suffix:
Gender:F
Credentials:LPN-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3945 E 131ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4760
Mailing Address - Country:US
Mailing Address - Phone:216-858-9523
Mailing Address - Fax:
Practice Address - Street 1:3945 E 131ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-4760
Practice Address - Country:US
Practice Address - Phone:216-858-9523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH142079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse