MEDICARE: SHUDU LLC

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1003508706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHUDU LLC

Provider Business Mailing Address
First Line	:	3539 KEBIL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-1557
Country	:	US
Telephone Number	:	317-960-7074
Fax Number	:

Provider Business Practice Location Address
First Line	:	3539 KEBIL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-1557
Country	:	US
Telephone Number	:	317-960-7074
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHUKURU SHUDU DUNIA
Credential	:
Telephone Number	:	317-960-7074

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “SHUDU LLC ” Practice Location

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