MEDICARE: KENYA SHANEL WYNNE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224P00000X	Prosthetist
2	332BC3200X	Customized Equipment (DME)
3	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1861329732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA SHANEL WYNNE

Provider Business Mailing Address
First Line	:	530 BELAIRE AVE STE 102
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4686
Country	:	US
Telephone Number	:	757-818-4178
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 BELAIRE AVE STE 102
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4686
Country	:	US
Telephone Number	:	757-818-4178
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ KENYA SHANEL WYNNE ” Practice Location

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