Provider Demographics
NPI:1487896478
Name:SPIDELL, TANIKA SHAREE (DO)
Entity type:Individual
Prefix:
First Name:TANIKA
Middle Name:SHAREE
Last Name:SPIDELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:PROF
Other - First Name:SPIDELL
Other - Middle Name:CONSULTING SOLUTIONS
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1863 KIPLING DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1863 KIPLING DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3917
Practice Address - Country:US
Practice Address - Phone:703-382-7871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022068942084P0800X
OH34.0167492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry