Provider Demographics
NPI:1700485091
Name:HARDIMAN, SHAKYRA DEONSHA
Entity Type:Individual
Prefix:
First Name:SHAKYRA
Middle Name:DEONSHA
Last Name:HARDIMAN
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 1:50 W TOWN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4197
Mailing Address - Country:US
Mailing Address - Phone:800-324-8680
Mailing Address - Fax:
Practice Address - Street 1:50 W TOWN ST STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4197
Practice Address - Country:US
Practice Address - Phone:800-324-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide