MEDICARE: SHAQUANNA KRISTAL PICTON

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	374U00000X	Home Health Aide	644598	NY

General Provider Information

NPI Number	:	1821953134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAQUANNA KRISTAL PICTON

Provider Business Mailing Address
First Line	:	322 BEACH 30TH ST APT 1
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-2011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 BEACH 30TH ST APT 1
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-2011
Country	:	US
Telephone Number	:	929-757-2936
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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