Provider Demographics
NPI:1285497719
Name:ROCKER, SHATARA
Entity type:Individual
Prefix:
First Name:SHATARA
Middle Name:
Last Name:ROCKER
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 1:5900 ROCHE DR STE 555
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3272
Mailing Address - Country:US
Mailing Address - Phone:614-843-7432
Mailing Address - Fax:
Practice Address - Street 1:1925 E DUBLIN GRANVILLE RD STE 234
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3517
Practice Address - Country:US
Practice Address - Phone:614-843-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty