Provider Demographics
NPI:1528681152
Name:SHARKEY, TAQUSIA (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:
First Name:TAQUSIA
Middle Name:
Last Name:SHARKEY
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 SUFFOLK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3014
Mailing Address - Country:US
Mailing Address - Phone:317-518-0282
Mailing Address - Fax:
Practice Address - Street 1:8429 CASTLETON CORNER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3580
Practice Address - Country:US
Practice Address - Phone:317-518-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC204003451744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management