MEDICARE: SHAUN TERELLE MOORE

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1225960750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN TERELLE MOORE

Provider Business Mailing Address
First Line	:	3123 S 69TH AVE APT 2
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-3554
Country	:	US
Telephone Number	:	402-618-4535
Fax Number	:	531-344-6454

Provider Business Practice Location Address
First Line	:	6010 WENNINGHOFF RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1903
Country	:	US
Telephone Number	:	402-618-4535
Fax Number	:

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

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ SHAUN TERELLE MOORE ” Practice Location

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