Provider Demographics
NPI:1639896715
Name:TANNER, SHAKEA MELIQUE
Entity Type:Individual
Prefix:
First Name:SHAKEA
Middle Name:MELIQUE
Last Name:TANNER
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 1:2121 TIFFIN AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-9504
Mailing Address - Country:US
Mailing Address - Phone:419-434-1431
Mailing Address - Fax:567-525-5091
Practice Address - Street 1:2121 TIFFIN AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-9504
Practice Address - Country:US
Practice Address - Phone:419-434-1431
Practice Address - Fax:567-525-5091
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator