MEDICARE: KAYLEIGH ELIZABETH SHRYOCK

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1780521708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEIGH ELIZABETH SHRYOCK

Provider Business Mailing Address
First Line	:	5015 ROUNDSTONE WAY APT 305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5015 ROUNDSTONE WAY APT 305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-2059
Country	:	US
Telephone Number	:	919-649-6169
Fax Number	:

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

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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