MEDICARE: SHYLANIA HODGE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1083478382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHYLANIA HODGE

Provider Business Mailing Address
First Line	:	9607 KINCEY AVE
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9140
Country	:	US
Telephone Number	:	704-686-7904
Fax Number	:

Provider Business Practice Location Address
First Line	:	9607 KINCEY AVE
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9140
Country	:	US
Telephone Number	:	704-686-7904
Fax Number	:

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

Provider Enumeration Date	:	02/08/2024
Last Update Date	:	12/16/2025

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Directions to “ SHYLANIA HODGE ” Practice Location

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