MEDICARE: SHUNTA DAILEY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1710309885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUNTA DAILEY

Provider Business Mailing Address
First Line	:	110 PLANTATION DR
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-6129
Country	:	US
Telephone Number	:	979-297-3802
Fax Number	:	979-297-3993

Provider Business Practice Location Address
First Line	:	110 PLANTATION DR
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-6129
Country	:	US
Telephone Number	:	979-297-3802
Fax Number	:	979-297-3993

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

Provider Enumeration Date	:	01/09/2014
Last Update Date	:	01/09/2014

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Directions to “ SHUNTA DAILEY ” Practice Location

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