Provider Demographics
NPI:1063810794
Name:GRAHAM, SHEMIKA ARIEL (CNA-DT)
Entity type:Individual
Prefix:MS
First Name:SHEMIKA
Middle Name:ARIEL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CNA-DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAIN BROOK CT
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2204
Mailing Address - Country:US
Mailing Address - Phone:443-621-5530
Mailing Address - Fax:410-517-0341
Practice Address - Street 1:66 MAIN BROOK CT
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2204
Practice Address - Country:US
Practice Address - Phone:443-621-5530
Practice Address - Fax:410-517-0341
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00128958376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide