MEDICARE: SHAMIKA A GORDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	343900000X	Non-emergency Medical Transport (VAN)
3	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1467053710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMIKA A GORDON

Provider Business Mailing Address
First Line	:	1074 VALDES AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2636
Country	:	US
Telephone Number	:	330-780-6187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1074 VALDES AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-2636
Country	:	US
Telephone Number	:	330-780-6187
Fax Number	:

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

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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Directions to “ SHAMIKA A GORDON ” Practice Location

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