Provider Demographics
NPI:1154003994
Name:BRAZILE, THERESA SHARNELL
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:SHARNELL
Last Name:BRAZILE
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 1:1620 SUMMIT RD APT 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2031
Mailing Address - Country:US
Mailing Address - Phone:513-616-1113
Mailing Address - Fax:
Practice Address - Street 1:1620 SUMMIT RD APT 4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2031
Practice Address - Country:US
Practice Address - Phone:513-616-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker