MEDICARE: SHONTE PATRICE MCBRIDE

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	:	1124979018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTE PATRICE MCBRIDE

Provider Business Mailing Address
First Line	:	3305 TIMBERHILL DR APT 202
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E RUDISILL BLVD STE 100B
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-1756
Country	:	US
Telephone Number	:	260-255-3665
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ SHONTE PATRICE MCBRIDE ” Practice Location

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