Provider Demographics
NPI:1457172801
Name:EDWARDS, TADIMIKA SHARRON
Entity type:Individual
Prefix:
First Name:TADIMIKA
Middle Name:SHARRON
Last Name:EDWARDS
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 1:372 WALDO AVE SE APT 2B
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4434
Mailing Address - Country:US
Mailing Address - Phone:503-580-5809
Mailing Address - Fax:
Practice Address - Street 1:372 WALDO AVE SE APT 2B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4434
Practice Address - Country:US
Practice Address - Phone:503-580-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist