MEDICARE: JASMINE SHENICE MARTIN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1790250330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE SHENICE MARTIN

Provider Business Mailing Address
First Line	:	131 BELMONT RIDGE DR
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-4086
Country	:	US
Telephone Number	:	919-602-8862
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 BLAIRHILL RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-1565
Country	:	US
Telephone Number	:	704-209-1021
Fax Number	:	980-203-2170

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

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	10/10/2018

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Directions to “ JASMINE SHENICE MARTIN ” Practice Location

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