MEDICARE: MRS. SHAMEKA ASHAWN RAINES

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	253Z00000X	In Home Supportive Care Agency		FL

General Provider Information

NPI Number	:	1124629134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAMEKA ASHAWN RAINES

Provider Business Mailing Address
First Line	:	111 N BAY ST
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-1431
Country	:	US
Telephone Number	:	850-899-0599
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N BAY ST
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-1431
Country	:	US
Telephone Number	:	850-899-0599
Fax Number	:

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

Provider Enumeration Date	:	11/05/2020
Last Update Date	:	11/05/2020

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