Provider Demographics
NPI:1811653850
Name:SHARROCK, SHAVONTIA
Entity type:Individual
Prefix:
First Name:SHAVONTIA
Middle Name:
Last Name:SHARROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAVONTIA
Other - Middle Name:
Other - Last Name:SHARROCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1421 LEXINGTON AVE # 268
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2629
Mailing Address - Country:US
Mailing Address - Phone:419-560-1168
Mailing Address - Fax:
Practice Address - Street 1:661 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903
Practice Address - Country:US
Practice Address - Phone:419-560-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
251J00000X, 374U00000X, 385HR2065X, 376J00000X, 385HR2060X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child