Provider Demographics
NPI:1285206771
Name:THOMPSON, SCHARMONA CHARDONNAY
Entity Type:Individual
Prefix:
First Name:SCHARMONA
Middle Name:CHARDONNAY
Last Name:THOMPSON
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 1:3637 E 114TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-2537
Mailing Address - Country:US
Mailing Address - Phone:216-533-7386
Mailing Address - Fax:
Practice Address - Street 1:1700 E 13TH ST STE 114
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3285
Practice Address - Country:US
Practice Address - Phone:216-621-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH494315315Medicaid