Provider Demographics
NPI:1548088842
Name:GOODA, SHARA BRIANA
Entity type:Individual
Prefix:
First Name:SHARA
Middle Name:BRIANA
Last Name:GOODA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARA
Other - Middle Name:BRIAN
Other - Last Name:DEVEREUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:932 E 1375 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-7731
Mailing Address - Country:US
Mailing Address - Phone:801-603-6909
Mailing Address - Fax:
Practice Address - Street 1:932 E 1375 N
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-7731
Practice Address - Country:US
Practice Address - Phone:801-603-6909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management