Provider Demographics
NPI:1295204501
Name:SIBLEY, TAKISHA V
Entity Type:Individual
Prefix:
First Name:TAKISHA
Middle Name:V
Last Name:SIBLEY
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 1:367 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1138
Mailing Address - Country:US
Mailing Address - Phone:330-604-9862
Mailing Address - Fax:
Practice Address - Street 1:367 GRAND AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1138
Practice Address - Country:US
Practice Address - Phone:330-604-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)