MEDICARE: MS. HOLLY NOEL SHIRA

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1033716337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLY NOEL SHIRA

Provider Business Mailing Address
First Line	:	7612 SESSIS DR
Second Line	:
City	:	WORTHINGTON
State	:	OH
Zip	:	43085-5318
Country	:	US
Telephone Number	:	614-749-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	4806 KINGSHILL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6204
Country	:	US
Telephone Number	:	614-749-0104
Fax Number	:

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

Provider Enumeration Date	:	10/08/2020
Last Update Date	:	10/08/2020

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Directions to “ MS. HOLLY NOEL SHIRA ” Practice Location

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