MEDICARE: SHONTERRA PATRICE STEVENS

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1306667837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONTERRA PATRICE STEVENS

Provider Business Mailing Address
First Line	:	1059 MAIN ST
Second Line	:
City	:	BUFFALO
State	:	SC
Zip	:	29321-3039
Country	:	US
Telephone Number	:	864-441-0045
Fax Number	:

Provider Business Practice Location Address
First Line	:	1059 MAIN ST
Second Line	:
City	:	BUFFALO
State	:	SC
Zip	:	29321-3039
Country	:	US
Telephone Number	:	864-441-0045
Fax Number	:

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

Provider Enumeration Date	:	10/17/2024
Last Update Date	:	10/17/2024

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Directions to “ SHONTERRA PATRICE STEVENS ” Practice Location

Language	Start Address	Practice Location

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