MEDICARE: SHANIKA EDWARDS

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	235Z00000X	Speech-Language Pathologist	36727	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558850974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIKA EDWARDS

Provider Business Mailing Address
First Line	:	2510 WILLOW SPRINGS LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8845
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 WILLOW SPRINGS LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8845
Country	:	US
Telephone Number	:	832-922-2471
Fax Number	:

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

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	05/02/2018

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Directions to “ SHANIKA EDWARDS ” Practice Location

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