MEDICARE: SHANICHA MCNEIL

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	171W00000X	Contractor
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1689100554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANICHA MCNEIL

Provider Business Mailing Address
First Line	:	505 MANN ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-6237
Country	:	US
Telephone Number	:	910-322-4506
Fax Number	:	910-322-4506

Provider Business Practice Location Address
First Line	:	2007 RAMSEY ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28301-4163
Country	:	US
Telephone Number	:	910-322-4506
Fax Number	:

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

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	07/16/2024

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Directions to “ SHANICHA MCNEIL ” Practice Location

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