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NPI Code Detail

MEDICARE: SHANNON HICKS

MEDICARE: SHANNON HICKS
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
1171M00000XCase Manager/Care Coordinator
2104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679835375
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON HICKS
Provider Business Mailing Address
First Line : 1673 MASON AVE STE 100
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5516
Country : US
Telephone Number : 386-846-3955
Fax Number : 386-873-0366
Provider Business Practice Location Address
First Line : 1673 MASON AVE STE 100
Second Line :
City : DAYTONA BEACH
State : FL
Zip : 32117-5516
Country : US
Telephone Number : 386-846-3955
Fax Number : 386-873-0366
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2012
Last Update Date : 05/05/2022

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Directions to “ SHANNON HICKS ” Practice Location

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