MEDICARE: SHENIQUA MARSHALL MASTER HERBALIST

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		GA
2	374K00000X	Religious Nonmedical Practitioner		GA

General Provider Information

NPI Number	:	1902464407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENIQUA MARSHALL MASTER HERBALIST

Provider Business Mailing Address
First Line	:	3390 N LUMPKIN RD APT 4107
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31903-6606
Country	:	US
Telephone Number	:	229-364-2721
Fax Number	:

Provider Business Practice Location Address
First Line	:	3390 N LUMPKIN RD APT 4107
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31903-6606
Country	:	US
Telephone Number	:	229-364-2721
Fax Number	:

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

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/15/2025

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