Shawla Clark

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

53623601 Issued in PA

Practice address

2047 Locust St FL 4
Philadelphia, PA 19103-5613

Phone

(267) 773-8525

NPI assigned

Jan 25, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• A Mom of 2 Sons 1 Angel LLC

  • In Home Supportive Care Agency
  • Philadelphia, PA
  • NPI 1326707316
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611532800000",
    "number": "1245820166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2047 LOCUST ST FL 4",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191035613",
            "telephone_number": "267-773-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2047 LOCUST ST FL 4",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191035613",
            "telephone_number": "267-773-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHAWLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "PA",
            "license": "53623601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachael Clark, M.D.
• Randall Clark, LCSW
• Richard Joseph Clark, D.M.D.
• Ryan Clark, PA
• Saundra C Clark, DMD
• Sierra Clark
• Skyler Clark, MD
• Stephanie Clark, DMD
• Stephanie Lynn Clark, M.D.
• Stephen Clark, NURSE PRACTITIONER

• In Home Supportive Care Agency in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• In Home Supportive Care Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.