MEDICARE: SHANIECE FARLEY

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	376J00000X	Homemaker
2	376K00000X	Nurse's Aide		OH
3	164W00000X	Licensed Practical Nurse	185637	OH

General Provider Information

NPI Number	:	1487169033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANIECE FARLEY

Provider Business Mailing Address
First Line	:	24700 ALBERTON RD
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2353
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 LONG RUN LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-5615
Country	:	US
Telephone Number	:	216-294-9131
Fax Number	:

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

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	07/10/2024

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Directions to “ SHANIECE FARLEY ” Practice Location

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