MEDICARE: SHAQSRIDE 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1467067595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAQSRIDE LLC

Provider Business Mailing Address
First Line	:	15506 PARKGATE DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-7389
Country	:	US
Telephone Number	:	804-300-3434
Fax Number	:

Provider Business Practice Location Address
First Line	:	15506 PARKGATE DR
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-7389
Country	:	US
Telephone Number	:	804-300-3434
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAKEEL ALI
Credential	:
Telephone Number	:	804-300-3434

Provider Enumeration Date	:	09/15/2020
Last Update Date	:	09/15/2020

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Directions to “SHAQSRIDE LLC ” Practice Location

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