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NPI Code Detail

MEDICARE: SHANICQUA LEOLA SALIU

MEDICARE: SHANICQUA LEOLA SALIU
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
1106S00000XBehavior TechnicianRBT-24-346360GA

General Provider Information

NPI Number : 1033942511
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANICQUA LEOLA SALIU
Provider Business Mailing Address
First Line : 481 ELMA G MILES PKWY STE B
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-4004
Country : US
Telephone Number : 912-532-9774
Fax Number : 912-221-3085
Provider Business Practice Location Address
First Line : 481 ELMA G MILES PKWY STE B
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-4004
Country : US
Telephone Number : 912-532-9774
Fax Number : 912-221-3085
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2024
Last Update Date : 08/21/2024

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Directions to “ SHANICQUA LEOLA SALIU ” Practice Location

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