MEDICARE: MS. ANNABELLA IVY SHOEMAKER

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	106S00000X	Behavior Technician		WV

General Provider Information

NPI Number	:	1740116433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNABELLA IVY SHOEMAKER

Provider Business Mailing Address
First Line	:	PO BOX 26
Second Line	:
City	:	THOMAS
State	:	WV
Zip	:	26292-0026
Country	:	US
Telephone Number	:	681-481-2175
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 S DAVIS AVE
Second Line	:
City	:	ELKINS
State	:	WV
Zip	:	26241-3529
Country	:	US
Telephone Number	:	304-801-3258
Fax Number	:

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

Provider Enumeration Date	:	06/20/2026
Last Update Date	:	06/20/2026

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