MEDICARE: SHAWNTAE MONIQUE BRYANT

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	251E00000X	Home Health Agency
2	251F00000X	Home Infusion Agency

General Provider Information

NPI Number	:	1033963236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNTAE MONIQUE BRYANT

Provider Business Mailing Address
First Line	:	27600 CHARDON RD APT 366
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44092-2776
Country	:	US
Telephone Number	:	440-223-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	35400 EUCLID AVE APT A106
Second Line	:
City	:	WILLOUGHBY HILLS
State	:	OH
Zip	:	44094-4520
Country	:	US
Telephone Number	:	440-667-8947
Fax Number	:

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

Provider Enumeration Date	:	04/15/2024
Last Update Date	:	04/15/2024

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