MEDICARE: SHANIYA SCOVIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker	1831722	OH

General Provider Information

NPI Number	:	1093302366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIYA SCOVIL

Provider Business Mailing Address
First Line	:	3860 E 149TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1104
Country	:	US
Telephone Number	:	216-798-3521
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 E 149TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1104
Country	:	US
Telephone Number	:	216-450-0895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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Directions to “ SHANIYA SCOVIL ” Practice Location

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