Healthcare Provider Details

I. General information

NPI: 1265780829
Provider Name (Legal Business Name): SHAMICA ANN HANIFF OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 STUART ANDREW BLVD
CHARLOTTE NC
28217-1589
US

IV. Provider business mailing address

1006 PARKES ST
MATTHEWS NC
28105-5970
US

V. Phone/Fax

Practice location:
  • Phone: 980-343-6960
  • Fax:
Mailing address:
  • Phone: 646-591-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number017154-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number17662
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: