Healthcare Provider Details

I. General information

NPI: 1023725348
Provider Name (Legal Business Name): JAMEKA SHAW CNA, PCT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SESAME CT APT 1C
REISTERSTOWN MD
21136-6323
US

IV. Provider business mailing address

1 SESAME CT APT 1C
REISTERSTOWN MD
21136-6323
US

V. Phone/Fax

Practice location:
  • Phone: 443-740-7697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: