MEDICARE: SHAYLA FOREMAN

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	224P00000X	Prosthetist	CB134576	PA
2	1744P3200X	Prosthetics Case Management	CB134576	PA

General Provider Information

NPI Number	:	1619583986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAYLA FOREMAN

Provider Business Mailing Address
First Line	:	4237 MURRAY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-2903
Country	:	US
Telephone Number	:	412-521-0109
Fax Number	:

Provider Business Practice Location Address
First Line	:	4237 MURRAY AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-2903
Country	:	US
Telephone Number	:	412-521-0109
Fax Number	:

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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Directions to “ SHAYLA FOREMAN ” Practice Location

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