Provider Demographics
NPI:1396417051
Name:MEDICAL NANNY
Entity Type:Organization
Organization Name:MEDICAL NANNY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-560-1168
Mailing Address - Street 1:1421 LEXINGTON AVE # 268
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2629
Mailing Address - Country:US
Mailing Address - Phone:419-560-1168
Mailing Address - Fax:
Practice Address - Street 1:1421 LEXINGTON AVE # 268
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2629
Practice Address - Country:US
Practice Address - Phone:419-560-1168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty