MEDICARE: SHANIECA TAYLOR

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	324785	NC

General Provider Information

NPI Number	:	1417748377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIECA TAYLOR

Provider Business Mailing Address
First Line	:	149 CYPRESS CIR APT A
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-4955
Country	:	US
Telephone Number	:	347-248-8605
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 CYPRESS CIR APT A
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-4955
Country	:	US
Telephone Number	:	347-248-8605
Fax Number	:

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

Provider Enumeration Date	:	05/13/2025
Last Update Date	:	05/13/2025

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