MEDICARE: SHAUN JAMAR BERRY SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	172A00000X	Driver	OH
2	251X00000X	Supports Brokerage Agency	OH
3	253Z00000X	In Home Supportive Care Agency	OH
4	261QA0600X	Adult Day Care Clinic/Center	OH
5	376J00000X	Homemaker	OH
6	374U00000X	Home Health Aide	OH

General Provider Information

NPI Number	:	1578367801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUN JAMAR BERRY SR.

Provider Business Mailing Address
First Line	:	7833 HARRISON AVE
Second Line	:
City	:	MOUNT HEALTHY
State	:	OH
Zip	:	45231-3111
Country	:	US
Telephone Number	:	513-544-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	7833 HARRISON AVE
Second Line	:
City	:	MOUNT HEALTHY
State	:	OH
Zip	:	45231-3111
Country	:	US
Telephone Number	:	513-544-0225
Fax Number	:

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

Provider Enumeration Date	:	04/03/2025
Last Update Date	:	04/03/2025

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