MEDICARE: SERENITY HEALTHCARE, LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1407526288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	2646 S LOOP W STE 423
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2678
Country	:	US
Telephone Number	:	713-234-7850
Fax Number	:	713-234-7844

Provider Business Practice Location Address
First Line	:	2646 S LOOP W STE 423
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2678
Country	:	US
Telephone Number	:	713-234-7850
Fax Number	:	713-234-7844

Authorized Official
Title or Position	:	NP/OWNER
Name	:	SHANEKWAH MELVILLE
Credential	:	FNP-C
Telephone Number	:	727-272-3265

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	05/01/2023

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