MEDICARE: TERRY MONIQUE SHRIVERS

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	342000000X	Transportation Network Company		OH

General Provider Information

NPI Number	:	1841995727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY MONIQUE SHRIVERS

Provider Business Mailing Address
First Line	:	4526 DARTMOOR DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45416-1802
Country	:	US
Telephone Number	:	937-360-8449
Fax Number	:

Provider Business Practice Location Address
First Line	:	4526 DARTMOOR DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45416-1802
Country	:	US
Telephone Number	:	937-360-8449
Fax Number	:

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

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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Directions to “ TERRY MONIQUE SHRIVERS ” Practice Location

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