MEDICARE: SHENIKA LATOYA ROGERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	104100000X	Social Worker
2	222Q00000X	Developmental Therapist	FL
3	252Y00000X	Early Intervention Provider Agency	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851579544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENIKA LATOYA ROGERS

Provider Business Mailing Address
First Line	:	4307 COLONY WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-6405
Country	:	US
Telephone Number	:	850-321-9315
Fax Number	:

Provider Business Practice Location Address
First Line	:	4307 COLONY WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-6405
Country	:	US
Telephone Number	:	850-321-9315
Fax Number	:

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

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	03/30/2020

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