MEDICARE: CHERIKA SHANTELL BODRICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	372500000X	Chore Provider
3	374U00000X	Home Health Aide
4	376J00000X	Homemaker
5	376K00000X	Nurse's Aide
6	172A00000X	Driver

General Provider Information

NPI Number	:	1336459148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIKA SHANTELL BODRICK

Provider Business Mailing Address
First Line	:	927 GLENFIDDICH DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2058
Country	:	US
Telephone Number	:	704-905-3346
Fax Number	:

Provider Business Practice Location Address
First Line	:	5941 PROVIDENCE RD
Second Line	:	APT 4
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-6708
Country	:	US
Telephone Number	:	704-905-3346
Fax Number	:

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

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/27/2010

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