MEDICARE: DANA SHIVERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	347C00000X	Private Vehicle
2	372600000X	Adult Companion
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
4	385HR2065X	Child Physical Disabilities Respite Care
5	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
6	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1013437243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA SHIVERS

Provider Business Mailing Address
First Line	:	PO BOX 3419
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-0008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 GOTHAM CT
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33563-6918
Country	:	US
Telephone Number	:	813-951-0136
Fax Number	:

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

Provider Enumeration Date	:	06/20/2017
Last Update Date	:	06/20/2017

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Directions to “ DANA SHIVERS ” Practice Location

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