MEDICARE: MS. SHAMAINE MOORE

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	376G00000X	Nursing Home Administrator	0020756	WI

General Provider Information

NPI Number	:	1548124894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAMAINE MOORE

Provider Business Mailing Address
First Line	:	4971 N 27TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5512
Country	:	US
Telephone Number	:	414-204-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 W FAIRMOUNT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-5523
Country	:	US
Telephone Number	:	414-426-4535
Fax Number	:

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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Directions to “ MS. SHAMAINE MOORE ” Practice Location

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