Individual
SHAHEDA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
414 HANEY AVE, SOUTH BEND, IN 46613-2409
(574) 210-5749
Mailing address
414 HANEY AVE, SOUTH BEND, IN 46613-2409
(574) 210-5749
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
IN
372600000X
Adult Companion
Primary
—
IN
Other
Enumeration date
09/08/2025
Last updated
09/08/2025
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