Active NPI
Shaheda Clark
- Adult Companion
- South Bend, IN
National Provider Identifier
1366323362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 414 Haney Ave
South Bend, IN 46613-2409 - Phone
- (574) 210-5749
- NPI assigned
- Sep 8, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| In Home Supportive Care Agency | 253Z00000X | IN | ||
| Adult Companion | 372600000X | IN | Primary |
Addresses
Primary practice location
414 Haney Ave
South Bend, IN 46613-2409
Mailing address
414 Haney Ave
South Bend, IN 46613-2409
Phone (574) 210-5749
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757289600000",
"number": "1366323362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "414 HANEY AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466132409",
"telephone_number": "574-210-5749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "414 HANEY AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466132409",
"telephone_number": "574-210-5749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "SHAHEDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-08",
"last_updated": "2025-09-08",
"certification_date": "2025-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "IN",
"license": null,
"primary": false
},
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": "IN",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.