Provider Demographics
NPI:1427947258
Name:CLARK, DARIA SHARMAINE
Entity type:Individual
Prefix:
First Name:DARIA
Middle Name:SHARMAINE
Last Name:CLARK
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 1:234 SILVERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4865
Mailing Address - Country:US
Mailing Address - Phone:469-862-6455
Mailing Address - Fax:
Practice Address - Street 1:234 SILVERCREEK DR
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-4865
Practice Address - Country:US
Practice Address - Phone:469-862-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies