Provider Demographics
NPI:1619789880
Name:MOORE, SHARIKA V
Entity type:Individual
Prefix:
First Name:SHARIKA
Middle Name:V
Last Name:MOORE
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 1:829 PLAZA DEL GADO
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4440
Mailing Address - Country:US
Mailing Address - Phone:602-723-6645
Mailing Address - Fax:
Practice Address - Street 1:829 PLAZA DEL GADO
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4440
Practice Address - Country:US
Practice Address - Phone:602-723-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-14047310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility