MEDICARE: MS. SHANICE DUNCAN BT

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1295620243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANICE DUNCAN BT

Provider Business Mailing Address
First Line	:	717 E 79TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3511
Country	:	US
Telephone Number	:	917-507-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 E 79TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3511
Country	:	US
Telephone Number	:	917-507-4505
Fax Number	:

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

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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