MEDICARE: SHANAN LAY

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	251E00000X	Home Health Agency	34666	FL
2	251E00000X	Home Health Agency	239003	FL

General Provider Information

NPI Number	:	1568144681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANAN LAY

Provider Business Mailing Address
First Line	:	3701 N 54TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1423
Country	:	US
Telephone Number	:	561-244-2513
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 N 54TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1423
Country	:	US
Telephone Number	:	561-244-2513
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “ SHANAN LAY ” Practice Location

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