MEDICARE: SHANELLE MONIQUE GRIFFIN RN

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	163W00000X	Registered Nurse	926274	TX

General Provider Information

NPI Number	:	1740144807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANELLE MONIQUE GRIFFIN RN

Provider Business Mailing Address
First Line	:	1101 W 40TH ST # 102
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3609
Country	:	US
Telephone Number	:	512-920-2414
Fax Number	:	484-218-3128

Provider Business Practice Location Address
First Line	:	1101 W 40TH ST # 102
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3609
Country	:	US
Telephone Number	:	512-920-2414
Fax Number	:	484-218-3128

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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