MEDICARE: SHKAILA 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	171W00000X	Contractor

General Provider Information

NPI Number	:	1386575041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHKAILA MOORE

Provider Business Mailing Address
First Line	:	PO BOX 4261
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-0261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6918 N 39TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-2515
Country	:	US
Telephone Number	:	531-395-6300
Fax Number	:

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

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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Directions to “ SHKAILA MOORE ” Practice Location

Language	Start Address	Practice Location

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