Provider Demographics
NPI:1265168025
Name:HARLEY, SHACOLE
Entity type:Individual
Prefix:
First Name:SHACOLE
Middle Name:
Last Name:HARLEY
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 1:222 BASSWOOD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3122
Mailing Address - Country:US
Mailing Address - Phone:937-204-8717
Mailing Address - Fax:
Practice Address - Street 1:222 BASSWOOD AVE APT 4
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3122
Practice Address - Country:US
Practice Address - Phone:937-204-8717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty