MEDICARE: SHANIQUA GREY

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	163WH0200X	Home Health Registered Nurse	RN735601	PA
2	163W00000X	Registered Nurse	RN735601	PA

General Provider Information

NPI Number	:	1053121962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIQUA GREY

Provider Business Mailing Address
First Line	:	6375 PENN AVE STE B
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206-4010
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 SYLVANIA AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15235-4460
Country	:	US
Telephone Number	:	412-663-3588
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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Directions to “ SHANIQUA GREY ” Practice Location

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