MEDICARE: SHAEMAA ESAM KOBARLI

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	374U00000X	Home Health Aide	IHCP-2156	SC

General Provider Information

NPI Number	:	1659118578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAEMAA ESAM KOBARLI

Provider Business Mailing Address
First Line	:	601 W OAK CIRCLE DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6279
Country	:	US
Telephone Number	:	207-749-8508
Fax Number	:

Provider Business Practice Location Address
First Line	:	5907 N KINGS HWY # 2
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2329
Country	:	US
Telephone Number	:	207-749-8508
Fax Number	:

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

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/09/2024

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