MEDICARE: SHEMEANNA BRISCOE

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1164110854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEMEANNA BRISCOE

Provider Business Mailing Address
First Line	:	18482 KUYKENDAHL RD STE 101
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-8123
Country	:	US
Telephone Number	:	346-430-1282
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 CYPRESS CREEK PKWY STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4108
Country	:	US
Telephone Number	:	346-430-1282
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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Directions to “ SHEMEANNA BRISCOE ” Practice Location

Language	Start Address	Practice Location

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