MEDICARE: SHANEKA CHANTEL BEVERLY

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1649876954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANEKA CHANTEL BEVERLY

Provider Business Mailing Address
First Line	:	772 KENILWORTH TER NE APT 6
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-1861
Country	:	US
Telephone Number	:	202-749-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 M ST NW APT 1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-3663
Country	:	US
Telephone Number	:	202-702-7164
Fax Number	:

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

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	12/10/2020

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Directions to “ SHANEKA CHANTEL BEVERLY ” Practice Location

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