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NPI Code Detail

MEDICARE: SHACOYA ROSS LPN

MEDICARE: SHACOYA ROSS LPN
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
1164W00000XLicensed Practical Nurse96398NC

General Provider Information

NPI Number : 1568322519
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHACOYA ROSS LPN
Provider Business Mailing Address
First Line : 4813 KITLEDGE DR
Second Line :
City : RALEIGH
State : NC
Zip : 27610-6624
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6118 SAINT GILES ST STE 130
Second Line :
City : RALEIGH
State : NC
Zip : 27612-7099
Country : US
Telephone Number : 919-910-0800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2025
Last Update Date : 11/13/2025

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Directions to “ SHACOYA ROSS LPN” Practice Location

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