Provider Demographics
NPI:1790104917
Name:PERRY, SHAKARA CHARDE
Entity Type:Individual
Prefix:
First Name:SHAKARA
Middle Name:CHARDE
Last Name:PERRY
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 1:490 BLOSSOM RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1808
Mailing Address - Country:US
Mailing Address - Phone:585-201-2725
Mailing Address - Fax:
Practice Address - Street 1:249D CHARWOOD CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-2703
Practice Address - Country:US
Practice Address - Phone:585-201-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10312102164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse