MEDICARE: SHAUNCEY MARIAH-KAY BERNECKER NP

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	363LA2200X	Adult Health Nurse Practitioner	CNP.023879	OH
2	363LA2100X	Acute Care Nurse Practitioner	CNP.023879	OH

General Provider Information

NPI Number	:	1417424375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNCEY MARIAH-KAY BERNECKER NP

Provider Business Mailing Address
First Line	:	237 WILLIAM HOWARD TAFT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7545 BEECHMONT AVE STE D
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4238
Country	:	US
Telephone Number	:	513-206-1320
Fax Number	:	513-232-8483

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

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	03/24/2022

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