Provider Demographics
NPI:1336459148
Name:BODRICK, CHERIKA SHANTELL
Entity Type:Individual
Prefix:
First Name:CHERIKA
Middle Name:SHANTELL
Last Name:BODRICK
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 1:927 GLENFIDDICH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2058
Mailing Address - Country:US
Mailing Address - Phone:704-905-3346
Mailing Address - Fax:
Practice Address - Street 1:5941 PROVIDENCE RD
Practice Address - Street 2:APT 4
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6708
Practice Address - Country:US
Practice Address - Phone:704-905-3346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver