Provider Demographics
NPI:1841995727
Name:SHRIVERS, TERRY MONIQUE
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:MONIQUE
Last Name:SHRIVERS
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 1:4526 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1802
Mailing Address - Country:US
Mailing Address - Phone:937-360-8449
Mailing Address - Fax:
Practice Address - Street 1:4526 DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1802
Practice Address - Country:US
Practice Address - Phone:937-360-8449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company