MEDICARE: SHANITA YVETTE JONHSON

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	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1215898168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANITA YVETTE JONHSON

Provider Business Mailing Address
First Line	:	375 SKYVIEW RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3749
Country	:	US
Telephone Number	:	216-609-8118
Fax Number	:	216-609-8118

Provider Business Practice Location Address
First Line	:	375 SKYVIEW RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-3749
Country	:	US
Telephone Number	:	216-609-8118
Fax Number	:	216-609-8118

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

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	12/10/2025

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