MEDICARE: SHAUNTE MERRELL

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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1396568960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNTE MERRELL

Provider Business Mailing Address
First Line	:	PSC 836 BOX 364
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09636-0007
Country	:	US
Telephone Number	:	345-933-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 836 BOX 364
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09636-0007
Country	:	US
Telephone Number	:	345-933-9621
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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Directions to “ SHAUNTE MERRELL ” Practice Location

Language	Start Address	Practice Location

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