MEDICARE: MRS. SHELLEY SHANAY JUGGINS CNA AND RMA AND BSHA

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	374U00000X	Home Health Aide		VA

General Provider Information

NPI Number	:	1043800121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHELLEY SHANAY JUGGINS CNA AND RMA AND BSHA

Provider Business Mailing Address
First Line	:	691 WELSH DR
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-1156
Country	:	US
Telephone Number	:	703-687-8491
Fax Number	:

Provider Business Practice Location Address
First Line	:	691 WELSH DR
Second Line	:
City	:	RUTHER GLEN
State	:	VA
Zip	:	22546-1156
Country	:	US
Telephone Number	:	703-687-8491
Fax Number	:

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

Provider Enumeration Date	:	01/22/2021
Last Update Date	:	01/22/2021

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