Provider Demographics
NPI:1912544354
Name:RODDY, SHEKA (LVN)
Entity Type:Individual
Prefix:
First Name:SHEKA
Middle Name:
Last Name:RODDY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:SHEKA
Other - Middle Name:
Other - Last Name:RANDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 L THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5002
Mailing Address - Country:US
Mailing Address - Phone:214-290-6727
Mailing Address - Fax:
Practice Address - Street 1:410 L THOMPSON ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-5002
Practice Address - Country:US
Practice Address - Phone:214-290-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193964164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse