MEDICARE: TAMINKA RENEE MOON

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1053257980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMINKA RENEE MOON

Provider Business Mailing Address
First Line	:	5131 ARCH ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1505
Country	:	US
Telephone Number	:	216-299-5230
Fax Number	:

Provider Business Practice Location Address
First Line	:	5131 ARCH ST
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1505
Country	:	US
Telephone Number	:	216-299-5230
Fax Number	:

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

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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Directions to “ TAMINKA RENEE MOON ” Practice Location

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