MEDICARE: SHANIQUA NICOLE ADANANDUS CDCA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CDCA.167939	OH

General Provider Information

NPI Number	:	1215410998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIQUA NICOLE ADANANDUS CDCA

Provider Business Mailing Address
First Line	:	1289 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2838
Country	:	US
Telephone Number	:	614-252-8834
Fax Number	:

Provider Business Practice Location Address
First Line	:	3797 E DESHLER AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-3339
Country	:	US
Telephone Number	:	614-674-7641
Fax Number	:

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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