MEDICARE: SHAMON CARE LLC

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1255193363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAMON CARE LLC

Provider Business Mailing Address
First Line	:	2539 NADINE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 NADINE DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2358
Country	:	US
Telephone Number	:	586-770-9537
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BADRIA SHAMON
Credential	:
Telephone Number	:	586-770-9537

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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