MEDICARE: SHANNA SENIOR

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

General Provider Information

NPI Number	:	1598303323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNA SENIOR

Provider Business Mailing Address
First Line	:	416 N WEST ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-3678
Country	:	US
Telephone Number	:	229-515-4352
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 N WEST ST
Second Line	:
City	:	BAINBRIDGE
State	:	GA
Zip	:	39817-3678
Country	:	US
Telephone Number	:	229-515-4352
Fax Number	:

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

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	01/08/2020

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Directions to “ SHANNA SENIOR ” Practice Location

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