Provider Demographics
NPI:1194190108
Name:JOHNSON, SHARDA (HHA)
Entity Type:Individual
Prefix:
First Name:SHARDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 BURLEIGH RD
Mailing Address - Street 2:1ST FL
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1265
Mailing Address - Country:US
Mailing Address - Phone:440-990-6035
Mailing Address - Fax:
Practice Address - Street 1:4780 BURLEIGH RD
Practice Address - Street 2:1ST FL
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1265
Practice Address - Country:US
Practice Address - Phone:440-990-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide