Provider Demographics
NPI:1669830501
Name:GOLDSBY, SHARRESE MONIQUE (LPN)
Entity type:Individual
Prefix:
First Name:SHARRESE
Middle Name:MONIQUE
Last Name:GOLDSBY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 NOBLE RD APT 404
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2130
Mailing Address - Country:US
Mailing Address - Phone:216-659-4004
Mailing Address - Fax:
Practice Address - Street 1:2440 NOBLE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2165
Practice Address - Country:US
Practice Address - Phone:216-659-4004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151539164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse