Provider Demographics
NPI:1588489546
Name:CAROLINA, SHANQUIEE TYKIRAH
Entity type:Individual
Prefix:
First Name:SHANQUIEE
Middle Name:TYKIRAH
Last Name:CAROLINA
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 1:1838 KENT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-3019
Mailing Address - Country:US
Mailing Address - Phone:614-290-8525
Mailing Address - Fax:
Practice Address - Street 1:1838 KENT ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-3019
Practice Address - Country:US
Practice Address - Phone:614-290-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide