Provider Demographics
NPI:1437836269
Name:SHARP, TONYA LAVETT (STNA)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LAVETT
Last Name:SHARP
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 LORETTA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1416
Mailing Address - Country:US
Mailing Address - Phone:614-405-4945
Mailing Address - Fax:
Practice Address - Street 1:1405 LORETTA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1416
Practice Address - Country:US
Practice Address - Phone:614-405-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401230380411253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care