Provider Demographics
NPI:1538724703
Name:REEVES, SHARONDA S
Entity type:Individual
Prefix:MS
First Name:SHARONDA
Middle Name:S
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARONDA
Other - Middle Name:S
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:572 S WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2755
Mailing Address - Country:US
Mailing Address - Phone:614-948-8088
Mailing Address - Fax:
Practice Address - Street 1:527 S WAVERLEY ST
Practice Address - Street 2:COLUMBUS
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4321
Practice Address - Country:US
Practice Address - Phone:614-948-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization