MEDICARE: MRS. YVONNE E SHAKES

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	372600000X	Adult Companion	229803	FL
2	376J00000X	Homemaker	229803	FL
3	372500000X	Chore Provider		FL
4	3747P1801X	Personal Care Attendant		FL
5	376J00000X	Homemaker		FL

General Provider Information

NPI Number	:	1194909358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE E SHAKES

Provider Business Mailing Address
First Line	:	5738 HORTON RD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3740
Country	:	US
Telephone Number	:	813-737-2899
Fax Number	:	813-650-8654

Provider Business Practice Location Address
First Line	:	5738 HORTON RD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3740
Country	:	US
Telephone Number	:	813-737-2899
Fax Number	:	813-650-8654

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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