Healthcare Provider Details

I. General information

NPI: 1881941839
Provider Name (Legal Business Name): SHAMIKA S WINTERS LMT, LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 11/30/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 S BYRNE RD
TOLEDO OH
43609-1005
US

IV. Provider business mailing address

3717 REVERE DR
TOLEDO OH
43612-1034
US

V. Phone/Fax

Practice location:
  • Phone: 419-382-7400
  • Fax: 419-382-9170
Mailing address:
  • Phone: 567-686-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.019522
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: