MEDICARE: SHANI WALKER

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	363A00000X	Physician Assistant	50.004472	OH

General Provider Information

NPI Number	:	1558730515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANI WALKER

Provider Business Mailing Address
First Line	:	1530 NEEDMORE RD STE 300
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3980
Country	:	US
Telephone Number	:	937-277-4274
Fax Number	:	937-277-8476

Provider Business Practice Location Address
First Line	:	1530 NEEDMORE RD STE 300
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45414-3980
Country	:	US
Telephone Number	:	937-277-4274
Fax Number	:	937-277-8476

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

Provider Enumeration Date	:	09/21/2015
Last Update Date	:	09/21/2015

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Directions to “ SHANI WALKER ” Practice Location

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