MEDICARE: SHADERICA HARRIS

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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1700759883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADERICA HARRIS

Provider Business Mailing Address
First Line	:	4004 LONE ROCK LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-1010
Country	:	US
Telephone Number	:	214-789-6530
Fax Number	:	469-694-0801

Provider Business Practice Location Address
First Line	:	4004 LONE ROCK LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-1010
Country	:	US
Telephone Number	:	214-789-6530
Fax Number	:	469-694-0801

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

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	09/25/2025

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Directions to “ SHADERICA HARRIS ” Practice Location

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