MEDICARE: SHALONDRA SCOTT

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1295474997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALONDRA SCOTT

Provider Business Mailing Address
First Line	:	1401 EDGEWOOD LN
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3422
Country	:	US
Telephone Number	:	229-255-5721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 EDGEWOOD LN
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31707-3422
Country	:	US
Telephone Number	:	229-255-5721
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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Directions to “ SHALONDRA SCOTT ” Practice Location

Language	Start Address	Practice Location

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