MEDICARE: MRS. ALLYSHA LATINA MARSHALL

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	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1053257493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLYSHA LATINA MARSHALL

Provider Business Mailing Address
First Line	:	2737 W WASHINGTON CENTER RD LOT 13
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1489
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2737 W WASHINGTON CENTER RD LOT 13
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1489
Country	:	US
Telephone Number	:	985-352-4215
Fax Number	:

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

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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