MEDICARE: SHONNA CATRINA LOVE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1538979232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHONNA CATRINA LOVE

Provider Business Mailing Address
First Line	:	127 S GRAY AVE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-5216
Country	:	US
Telephone Number	:	336-269-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 S GRAY AVE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19805-5216
Country	:	US
Telephone Number	:	336-269-8390
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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Directions to “ SHONNA CATRINA LOVE ” Practice Location

Language	Start Address	Practice Location

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