MEDICARE: SHAMIKA MARIE WHITE-LOVELACE HOME HEALTH AIDE

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	103TH0100X	Health Service Psychologist	SJ398635	OH

General Provider Information

NPI Number	:	1528554896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMIKA MARIE WHITE-LOVELACE HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	3886 BROOKSIDE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5105
Country	:	US
Telephone Number	:	216-386-2148
Fax Number	:

Provider Business Practice Location Address
First Line	:	3886 BROOKSIDE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5105
Country	:	US
Telephone Number	:	216-386-2148
Fax Number	:

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

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	07/10/2018

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