MEDICARE: STEPHANIE SHANTE BERRY

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

General Provider Information

NPI Number	:	1720639701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SHANTE BERRY

Provider Business Mailing Address
First Line	:	7777 BONHOMME AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1911
Country	:	US
Telephone Number	:	341-797-7136
Fax Number	:	314-786-0588

Provider Business Practice Location Address
First Line	:	7777 BONHOMME AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1911
Country	:	US
Telephone Number	:	341-797-7136
Fax Number	:	314-786-0588

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

Provider Enumeration Date	:	09/22/2019
Last Update Date	:	09/22/2019

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Directions to “ STEPHANIE SHANTE BERRY ” Practice Location

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