MEDICARE: SHAWANA Y MACKEY

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1497475446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWANA Y MACKEY

Provider Business Mailing Address
First Line	:	562 LUDWELL PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-2497
Country	:	US
Telephone Number	:	937-367-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	562 LUDWELL PL
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-2497
Country	:	US
Telephone Number	:	937-367-4254
Fax Number	:

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

Provider Enumeration Date	:	08/30/2022
Last Update Date	:	08/30/2022

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Directions to “ SHAWANA Y MACKEY ” Practice Location

Language	Start Address	Practice Location

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