MEDICARE: SHAQUALA DENISE ROBERTSON

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	372500000X	Chore Provider
2	3747P1801X	Personal Care Attendant		NE

General Provider Information

NPI Number	:	1710777131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAQUALA DENISE ROBERTSON

Provider Business Mailing Address
First Line	:	3101 HOLDREGE ST APT 1
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68503-1500
Country	:	US
Telephone Number	:	402-807-9931
Fax Number	:

Provider Business Practice Location Address
First Line	:	8055 O ST STE 119B
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-2565
Country	:	US
Telephone Number	:	402-421-1119
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	06/01/2026

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Directions to “ SHAQUALA DENISE ROBERTSON ” Practice Location

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