Provider Demographics
NPI:1962023739
Name:SADLER, MARDESHIA
Entity Type:Individual
Prefix:
First Name:MARDESHIA
Middle Name:
Last Name:SADLER
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 1:947 S SCHENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-3034
Mailing Address - Country:US
Mailing Address - Phone:330-531-3874
Mailing Address - Fax:
Practice Address - Street 1:947 S SCHENLEY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-3034
Practice Address - Country:US
Practice Address - Phone:330-531-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-02
Last Update Date:2020-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH513724Medicaid