Provider Demographics
NPI:1285353201
Name:GRAY, SHARYKA LANEE
Entity type:Individual
Prefix:
First Name:SHARYKA
Middle Name:LANEE
Last Name:GRAY
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 1:2815 MOZART WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6928
Mailing Address - Country:US
Mailing Address - Phone:317-456-6072
Mailing Address - Fax:317-534-3739
Practice Address - Street 1:2815 MOZART WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-6928
Practice Address - Country:US
Practice Address - Phone:317-456-6072
Practice Address - Fax:317-534-3739
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN22-015753-13747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program