Provider Demographics
NPI:1255192829
Name:MARSH, SHANIQUA SHANTI
Entity type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:SHANTI
Last Name:MARSH
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 1:2999 LEGIONARY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-6550
Mailing Address - Country:US
Mailing Address - Phone:220-465-9210
Mailing Address - Fax:
Practice Address - Street 1:2999 LEGIONARY ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-6550
Practice Address - Country:US
Practice Address - Phone:220-465-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174660164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty