Provider Demographics
NPI:1326703844
Name:TATUM, SHAMIKA D
Entity Type:Individual
Prefix:
First Name:SHAMIKA
Middle Name:D
Last Name:TATUM
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 1:2538 SHERIDAN RD SE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5284
Mailing Address - Country:US
Mailing Address - Phone:202-486-9710
Mailing Address - Fax:
Practice Address - Street 1:2538 SHERIDAN RD SE APT 2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5284
Practice Address - Country:US
Practice Address - Phone:202-486-9710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant