MEDICARE: SHERIKA SHAWAN AMORY LVN

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	3747P1801X	Personal Care Attendant
2	164X00000X	Licensed Vocational Nurse	188163	TX

General Provider Information

NPI Number	:	1508455130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERIKA SHAWAN AMORY LVN

Provider Business Mailing Address
First Line	:	13562 BLUE MARLIN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-4843
Country	:	US
Telephone Number	:	346-813-5792
Fax Number	:

Provider Business Practice Location Address
First Line	:	13562 BLUE MARLIN LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-4843
Country	:	US
Telephone Number	:	832-459-0371
Fax Number	:	281-783-2643

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

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	05/04/2021

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